Sample records for arthroscopic anterior cruciate

  1. Infection after arthroscopic anterior cruciate ligament reconstruction.

    PubMed

    Kim, Seung-Ju; Postigo, Ricardo; Koo, Sowon; Kim, Jong Hun

    2014-07-01

    Septic arthritis is a rare but potentially devastating complication of anterior cruciate ligament (ACL) reconstruction surgery. The purpose of this study was to provide an evidence-based summarization of the treatment and outcome of infection after ACL reconstruction with a pooled analysis of the reported cases. The authors conducted a systematic review of published studies that evaluated the outcome of septic arthritis after arthroscopic ACL reconstruction. A structured literature review of multiple databases referenced articles from 1950 to 2012. A total of 22,836 knees from 14 published studies were assessed. Postoperative septic arthritis occurred in 121 knees, with a pooled percentage of 0.5%. Mean duration of follow-up after ACL reconstruction was 53.6 months (range, 4-218 months). An average of 1.92 procedures (range, 1-5 procedures) were performed to eradicate the infection. The grafts were retained in 77% of cases. Postoperative intravenous antibiotics were used for at least 5 days (range, 5-90 days) after debridement. At final follow-up, mean postoperative Lysholm score was 80.2 (range, 23-100). No reinfection was observed in 121 patients. This study has helped to further elucidate the outcomes of infection after ACL reconstruction. Once an infection is encountered, culture-specific antibiotics and surgical joint irrigation with graft retention are recommended as initial treatment. Graft removal can be considered only for those infections resistant to initial treatment. PMID:24992054

  2. Arthroscopic reconstruction of the anterior cruciate ligament using allograft tendon.

    PubMed

    Wainer, R A; Clarke, T J; Poehling, G G

    1988-01-01

    Treatment of the anterior cruciate ligament (ACL)-deficient knee using an arthroscopic technique and freeze-dried allograft tendons in 23 patients was studied prospectively. Accurate placement of drill holes and anchoring positions for the allografts was effected through a standard arthroscopic approach combined with a 3 cm incision on the medial tibial flare. Candidates for reconstruction were those who were unable to tolerate brace therapy and who had no degenerative arthritis. The 23 patients were drawn from a group of 60 treated patients because their follow-up had been greater than or equal to 1 year. Their knees were assessed preoperatively and postoperatively with a Lysholm knee rating scale, Lachman test with KT-1000 arthrometric quantitation, pivot shift, Biodex test, and radiographs. Knee rating values improved in all knees, and only one patient had a significant deterioration in the KT-1000 reading. All patients with at least 20 months follow-up have resumed their preinjury activity levels. PMID:3166660

  3. Arthroscopic double-bundle anterior cruciate ligament reconstruction: an anatomic approach.

    PubMed

    Cha, Peter S; Brucker, Peter U; West, Robin V; Zelle, Boris A; Yagi, Masayoshi; Kurosaka, Masahiro; Fu, Freddie H

    2005-10-01

    The anterior cruciate ligament consists of 2 functional bundles, the anteromedial and the posterolateral bundle. Anterior cruciate ligament reconstruction has traditionally focused on recreating the anteromedial bundle, while the reconstruction of the posteromedial bundle has not routinely been addressed. The authors, from 2 academic centers, present a technique of arthroscopic anterior cruciate ligament reconstruction that restores both the anteromedial and the posterolateral bundle using either semitendinosus and gracilis autografts or tibialis anterior allografts. This technique represents a novel approach to restore the anteromedial and the posterolateral bundle at their anatomic insertion sites on both the tibia and the femur through separate bone tunnels. We believe that our double-bundle anatomic anterior cruciate ligament reconstruction closely reapproximates the native insertion sites of the anterior cruciate ligament on the tibia and the femur while more closely recreating the biomechanical function of the native ligament. PMID:16226666

  4. Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon composite autograft

    Microsoft Academic Search

    Dong-Wook Kim; Jong-Oh Kim; Jae-Doo You; Sung-Jae Kim; Hyun-Kon Kim

    2001-01-01

    At present, no single graft option clearly outperforms another. Autografts (patellar tendon, hamstring) and allografts (Achilles tendon, patellar tendon) are the grafts most often used. However, each grafts has advantages and disadvantages. Quadriceps tendon graft for anterior cruciate ligament reconstruction is not new, but an alternative composite graft is introduced here that consists of quadriceps tendon–patellar bone and bone obtained

  5. Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon composite autograft.

    PubMed

    Kim, D W; Kim, J O; You, J D; Kim, S J; Kim, H K

    2001-05-01

    At present, no single graft option clearly outperforms another. Autografts (patellar tendon, hamstring) and allografts (Achilles tendon, patellar tendon) are the grafts most often used. However, each grafts has advantages and disadvantages. Quadriceps tendon graft for anterior cruciate ligament reconstruction is not new, but an alternative composite graft is introduced here that consists of quadriceps tendon-patellar bone and bone obtained from a coring reamer used to create the tibial tunnel. This composite graft retains reduced morbidity while allowing the secure bone-to-bone fixation associated with bone-patellar tendon-bone graft. PMID:11337727

  6. Management of intraoperative complications in arthroscopic primary anterior cruciate ligament reconstruction.

    PubMed

    Charalambous, Charalambos P; Alvi, Farhan; Sutton, Paul M

    2015-04-01

    Arthroscopic anterior cruciate ligament reconstruction is a commonly performed procedure which is technically demanding and involves multiple surgical steps with the potential for a wide range of intraoperative complications. In this article, we review these potential complications and give algorithms for dealing with them based on our experience and published evidence. We discuss the use of both bone-patellar tendon-bone and hamstring grafts and examine complications associated with suspensory button and interference screw fixation. PMID:24752920

  7. Bilateral Medial Tibial Plateau Fracture after Arthroscopic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Cho, Chul Hyun; Lee, Kyung Jae; Jeon, Jong Hyuk

    2015-01-01

    Tibial plateau fractures after arthroscopic anterior cruciate ligament (ACL) reconstruction are rare, and only isolated cases have been reported. The authors describe a case of bilateral medial tibial plateau fracture following a minor motorcycle accident in a patient who underwent arthroscopic ACL reconstruction in the past. Two years and four months before the accident, the patient underwent an arthroscopically assisted ACL reconstruction using double-bundle technique on his left knee at a hospital. He had the same surgery using single-bundle technique on his right knee about eight months ago at another hospital. The fractures in his both involved knees occurred through the tibial tunnel and required open reduction with internal fixation. At three weeks after fixation, a second-look arthroscopy revealed intact ACLs in both knees. At five months follow-up, he was able to walk without instability on physical examination. Follow-up radiographs of the patient showed callus formations with healed fractures. PMID:26060613

  8. Bilateral Medial Tibial Plateau Fracture after Arthroscopic Anterior Cruciate Ligament Reconstruction.

    PubMed

    Bae, Ki Cheor; Cho, Chul Hyun; Lee, Kyung Jae; Jeon, Jong Hyuk

    2015-06-01

    Tibial plateau fractures after arthroscopic anterior cruciate ligament (ACL) reconstruction are rare, and only isolated cases have been reported. The authors describe a case of bilateral medial tibial plateau fracture following a minor motorcycle accident in a patient who underwent arthroscopic ACL reconstruction in the past. Two years and four months before the accident, the patient underwent an arthroscopically assisted ACL reconstruction using double-bundle technique on his left knee at a hospital. He had the same surgery using single-bundle technique on his right knee about eight months ago at another hospital. The fractures in his both involved knees occurred through the tibial tunnel and required open reduction with internal fixation. At three weeks after fixation, a second-look arthroscopy revealed intact ACLs in both knees. At five months follow-up, he was able to walk without instability on physical examination. Follow-up radiographs of the patient showed callus formations with healed fractures. PMID:26060613

  9. Graft selection in arthroscopic anterior cruciate ligament reconstruction

    PubMed Central

    D’Angelo, Franca; De Masi, Salvatore; Adriani, Ezio; Magaletti, Massimiliano; Lacorte, Eleonora; Laricchiuta, Paola; Sagliocca, Luciano; Morciano, Cristina; Mele, Alfonso

    2010-01-01

    Background Anterior cruciate ligament (ACL) surgical reconstruction is performed with the use of an autogenic, allogenic or synthetic graft. The document issued by the Italian National Guidelines System (SNLG, Sistema Nazionale Linee Guida) at the National Institute of Health aims to guide orthopaedic surgeons in selecting the optimal graft for ACL reconstruction using an evidence-based approach. Materials and methods A monodisciplinary panel was formed to define a restricted number of clinical questions, develop specific search strategies and critically appraise the literature using the grading of recommendations assessment, development, and evaluation (GRADE) method. The final draft was shared by the panel and then sent to four external referees to assess its readability and clarity, its clinical relevance and the feasibility of recommendations. Results Autograft shows moderate superiority compared with allograft, in relation to the relevant outcomes and the quality of selected evidence, after an appropriate risk–benefit assessment. Allograft shows higher failure rate and higher risk of infection. The panel recommends use of autografts; patellar tendon should be the first choice, due to its higher stability, while use of hamstring is indicated for subjects for whom knee pain can represent a particular problem (e.g., some categories of workers). Conclusions Autograft shows better performance compared with allograft and no significant heterogeneity in relation to relevant outcomes. The GRADE method allowed collation of all the information needed to draw up the recommendations, and to highlight the core points for discussion. PMID:21181226

  10. Quantitative evaluation after arthroscopic anterior cruciate ligament reconstruction. Allograft versus autograft.

    PubMed

    Shino, K; Nakata, K; Horibe, S; Inoue, M; Nakagawa, S

    1993-01-01

    We measured the anteroposterior ligamentous laxity and thigh muscle power in 92 subjects who were rated as successes after they had undergone arthroscopic anterior cruciate ligament reconstruction for unilateral anterior cruciate ligament insufficiency 18 to 36 months previously. The subjects were divided into 2 groups according to the type of graft: fresh-frozen allogenic tendon (N = 47) or central one third of the ipsilateral patellar tendon (N = 45). Instrumented drawer tests in the Lachman position were performed to measure anterior tibial displacement at 200 N (anterior laxity). Thigh muscle power was isokinetically measured with a Cybex II dynamometer. Significantly more anterior laxity was found in the reconstructed knees than in the contralateral normal knees regardless of graft material (paired t-test, P < 0.01), except for the male allograft patients. Although the mean anterior laxity difference between sides for the allograft patients was less than that for the autogenous ones, analysis of variance failed to demonstrate a statistically significant difference between the 2 groups if the comparison was strictly made within the same sex. Thigh muscle tests revealed that extension torque in the reconstructed knees was significantly less than that in the contralateral knees and analysis of variance showed that knee extension torque at 60 deg/sec for the allograft patients was significantly better than that of the autograft ones (P < 0.05). We concluded that the allograft procedure is advantageous over the patellar tendon autograft in terms of better restoration of anterior stability. PMID:8368425

  11. Fungal osteomyelitis after arthroscopic anterior cruciate ligament reconstruction: a case report with review of the literature.

    PubMed

    Sun, Lei; Zhang, Lei; Wang, Kai; Wang, Wei; Tian, Min

    2012-10-01

    Fungal osteomyelitis is a very rare complication after anterior cruciate ligament (ACL) reconstruction associated with catastrophic consequences. Herein, we present a case of such disastrous complication after ACL reconstruction. A 23-year-old man developed fever, swelling and pain of the affected knee from 18 days after arthroscopic ACL reconstruction. Therefore, he underwent arthroscopic debridement, removal of the graft and internal fixators, irrigation and suction drainage, successively. Negative results for serial bacterial cultures and smear examinations are obtained. However, computer tomography and X-ray examination showed massive bone destruction at 48 days after ACL reconstruction. As the first open debridement was performed at 50 days after ACL reconstruction, fungal infection was diagnosed based on finding Aspergillus hyphae in pathologic examination of the debrided bone sample. After the final debridement, a 12-cm bone loss in the distal femur was treated by Ilizarov's bone transport. The patient got solid arthrodesis of the affected knee without clinical infection at a year after the initial operation. In addition, a review of the literature regarding case reports of fungal osteomyelitis after ACL reconstruction is presented. PMID:22209694

  12. Arthrometric stability of horizontal versus vertical single-bundle arthroscopic anterior cruciate ligament reconstruction.

    PubMed

    Denti, Matteo; Arrigoni, Paolo; Volpi, Piero; Bait, Corrado; Sedran, Jean Claude; Randelli, Pietro

    2014-05-01

    The anteroposterior (AP) stability of standard anterior cruciate ligament (ACL) reconstruction, referred to as "vertical," was compared with that of a modified femoral position, referred to as "horizontal," which is lower than and anterior to an operative knee at 90° flexion. Two consecutive series of 50 patients underwent vertical and horizontal arthroscopic single-bundle ACL reconstruction, respectively. For vertical reconstruction, the clock position was chosen, placing the graft at 10:30 in right knees and 1:30 in left knees, 1 to 2 mm anterior to the posterior femoral cortical cortex and at the back of the resident ridge. In the horizontal reconstruction, the transplant replaced the original ligament insertion at approximately the 9:30 o'clock position in right knees and the 2:30 o'clock position in left knees, approximately 2 mm in front of the posterior femoral cortical cortex. One year after surgery, the results of stabilometric evaluation revealed good performance after horizontal transplant. The mean clinical results changed from 1.0 (±1.3) mm for vertical to 0.7 (±1.3) mm for horizontal reconstruction. PMID:24810813

  13. Arthroscopic treatment of a large lateral femoral notch in acute anterior cruciate ligament tear.

    PubMed

    Tauber, Mark; Fox, Michael; Koller, Heiko; Klampfer, Helmut; Resch, Herbert

    2008-11-01

    A 24-year-old professional soccer player suffered an acute anterior cruciate ligament tear associated with a radiologically evident impression fracture of the lateral femoral condyle, the so-called "lateral femoral notch sign". Following MRI validation of the injury with detection of an additional lateral meniscus tear, arthroscopy was carried out 3 days after the injury. Due to the extended impression of about 5 mm, arthroscopically assisted closed reduction of the depression fracture was performed. A 3.2 mm tunnel was drilled at the lateral femoral condyle in a supero-inferior direction using an ACL tibial guide and the depressed area could be restored using an elevator. The resulting subchondral bone defect in the femoral condyle was filled with freeze-dried human cancellous bone allograft. As a one-stage procedure ACL reconstruction was carried out using a hamstring tendon technique. At 1-year follow up the patient has returned to full sporting function, including playing soccer with a radiographically reduced lateral femoral notch sign. PMID:18060552

  14. [Combined anterior cruciate ligament and posterior cruciate ligament injury--technique and results of simultaneous arthroscopic reconstruction].

    PubMed

    Martinek, V; Imhoff, A B

    1998-01-01

    Simultaneous ACL and PCL ruptures are rare but serious injuries resulting in distinct instability of the knee joint followed by an early degenerative arthritis. This combined trauma, which is often accompanied by additional ligament lesions, originates from a knee dislocation. While the conservative treatment of this complex instability is abandoned, the operative procedures are not yet standardised. The timing of the cruciate ligament reconstruction depends on the additional injuries, but generally the postprimary treatment is performed. Autografts and allografts, which can be also combined, are available for the reconstruction of the cruciate ligaments. The arthroscopic assisted operation starts with the drilling of all tibial and femoral tunnels using standard ACL and PCL arthroscopic instruments. The PCL is positioned after the graft has been transported into the joint through an anterolateral port, the ACL graft is positioned through the tibial drill hole and both are anchored first on the femoral and then on the tibial site i.e. with interference screws. In the postoperative rehabilitation neither immobilisation nor brace are used and progressive range of motion is allowed. The arthroscopic assisted reconstructions of the ACL and increasingly of the PCL are becoming standard procedures, but the technically difficult combined ACL/PCL reconstruction is restricted to a small number of arthroscopists. The first clinical results demonstrate, that the arthroscopic operation is comparable to the open reconstruction. PMID:9816662

  15. Arthroscopic anterior cruciate ligament reconstruction using a flexible guide pin with a rigid reamer.

    PubMed

    Elliott, Michael P; Luedke, Colton C; Webb, Brian G

    2015-04-01

    Successful anterior cruciate ligament reconstruction depends heavily on accurate placement of the graft within the anatomical insertion of the native anterior cruciate ligament. Inaccurate placement can lead to graft failure and recurrent instability. Flexible guide pins and reamers have been developed to overcome some of the limitations of using transtibial and anteromedial portals to drill femoral tunnels. Early in our experience with flexible instruments, reamer breakage caused complications. We therefore developed a technique that uses a flexible guide pin with a rigid reamer to place the femoral tunnel in an anatomical position. This technique allows placement of longer anatomical tunnels through an anteromedial portal, reduces time spent with the knee in hyperflexion, provides better viewing, poses less risk of damage to the articular cartilage and neurovascular structures, and at a lower cost with less risk of reamer breakage. PMID:25844586

  16. Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon autograft: clinical outcome in 4–7 years

    Microsoft Academic Search

    Chih-Hwa Chen; Tai-Yuan Chuang; Kun-Chuang Wang; Wen-Jer Chen; Chun-Hsiung Shih

    2006-01-01

    Surgical reconstruction of the anterior cruciate ligament (ACL) is indicated in the ACL-deficient knee with symptomatic instability and multiple ligaments injuries. In the present study, we describe the clinical results of quadriceps tendon-patellar bone autograft for ACL reconstruction. From 1996 to 1998, the graft has been used in 38 patients. Thirty-four patients with complete final follow-up for 4–7 years were analyzed.

  17. Arthroscopically assisted anterior cruciate ligament reconstruction with the pes anserine tendonsComparison of results in acute and chronic ligament deficiency

    Microsoft Academic Search

    Nicholas A. Sgaglione; Wilson Del Pizzo; James M. Fox; Mark J. Friedman

    1993-01-01

    Fifty anterior cruciate ligament-deficient knees treated consecutively with arthroscopically assisted recon struction using a pes anserine tendon autograft were retrospectively studied. The mean followup was 36.7 months (range, 26 to 58). All patients had reconstruc tion with a double-stranded graft. The mean injury to surgery interval was 9.6 days in 22 patients (acute group) and 22.5 months in 28 patients

  18. Anterior cruciate ligament reconstruction. Autograft or allograft?

    PubMed

    DiStefano, V

    1993-01-01

    Refinements in arthroscopic techniques have fostered an upsurge in arthroscopically assisted anterior cruciate ligament reconstruction. This article explores the relative merits of autogenous and allogeneic tissue used for this purpose and describes several important technical points in the author's preferred method of surgery. PMID:8418970

  19. Arthroscopic anatomical double bundle anterior cruciate ligament reconstruction: A prospective longitudinal study

    PubMed Central

    Devgan, Ashish; Singh, Amanpreet; Gogna, Paritosh; Singla, Rohit; Magu, Narender Kumar; Mukhopadhyay, Reetadyuti

    2015-01-01

    Background: Single bundle anterior cruciate ligament (ACL) reconstruction has been the current standard of treatment for ACL deficiency. However, a significant subset of patients continue to report residual symptoms of instability with a poor pivot control. Cadaveric biomechanical studies have shown double bundle (DB) ACL reconstructions to restore the knee kinematics better. This study evaluates the outcome of DB ACL reconstruction. Materials and Methods: 30 consecutive patients who underwent anatomic DB ACL reconstruction were included in this prospective longitudinal study. There were all males with a mean age of 25 ± 7.45 years. All patients were prospectively evaluated using GeNouRoB (GNRB) arthrometer, functional knee scores (International Knee Documentation Committee [IKDC] and Lysholm) and postoperative magnetic resonance imaging (MRI) for comparing the graft orientation and footprint of the reconstructed ACL with that of the normal knee. Results: The average followup was 36.2 months. At the time of final followup the mean Lysholm score was 93.13 ± 3.31. As per the objective IKDC score, 26 patients (86.6%) were in Group A while 4 patients (13.3%) were in Group B. The mean differential anterior tibial translation by GNRB, arthrometer was 1.07 ± 0.8 mm (range 0.1-2.3 mm). All cases had a negative pivot shift test. MRI scans of operated and the contralateral normal knee showed the mean sagittal ACL tibial angle coronal ACL tibial angle and tibial ACL footprint to be in accordance with the values of the contralateral, normal knee. Conclusion: The study demonstrates that DB ACL reconstruction restores the ACL anatomically in terms of size and angle of orientation. However, long term studies are needed to further substantiate its role in decreasing the incidence of early osteoarthritic changes compared to the conventional single bundle reconstructions. PMID:26015600

  20. A novel graft preparation technique of the quadriceps tendon for arthroscopic double-bundle anterior cruciate ligament reconstruction.

    PubMed

    Park, Sang Eun; Ko, Yujin

    2013-01-01

    Surgical reconstruction is a general approach for an anterior cruciate ligament rupture. Techniques have evolved from single-bundle to double-bundle reconstruction to restore the 2 anatomically and functionally different bundles as much as possible. However, there is controversy regarding which method yields superior clinical outcomes. The purpose of this article is to introduce our new graft preparation method, which will potentially address the limitations of currently available double-bundle anterior cruciate ligament reconstruction procedures using the quadriceps tendon. The proximal portion of the graft is preserved in our method, instead of completely being split into 2 distinct graft bundles as previously suggested. We believe that the preserved portion can act as a biofunctional "safety circuit" in case of overloading and also help some synergistic actions of the 2 bundles. PMID:24265982

  1. Allograft maturation in anterior cruciate ligament reconstruction.

    PubMed

    Lee, Cassandra A; Meyer, Jeffrey V; Shilt, Jeffrey S; Poehling, Gary G

    2004-07-01

    This case report describes the histologic incorporation of a freeze-dried Achilles tendon allograft used for arthroscopic anterior cruciate ligament (ACL) reconstruction. The patient had regained stability from the procedure but had worsening pain over the medial compartment. The patient underwent total knee arthroplasty 2.5 years after ACL reconstruction. The surgeon was able to observe the graft in situ and examine the histology of the graft tunnel interface. This interface demonstrated Sharpey's fibers. PMID:15243424

  2. Anatomic Single and Double-Bundle Anterior Cruciate Ligament Reconstruction, Part 2: Clinical Application of Surgical Technique

    Microsoft Academic Search

    Jon Karlsson; James J. Irrgang; Carola F. van Eck; Kristian Samuelsson; Hector A. Mejia; Freddie H. Fu

    2011-01-01

    The anterior cruciate ligament has been and is of great interest to scientists and orthopaedic surgeons worldwide. Anterior cruciate ligament reconstruction was initially performed using an open approach. When the approach changed from open to arthroscopic reconstruction, a 2- and, later, 1-incision technique was applied. With time, researchers found that traditional arthroscopic single-bundle reconstruction did not fully restore rotational stability

  3. Bioengineered anterior cruciate ligament

    NASA Technical Reports Server (NTRS)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the particular developing tissue, some examples of the stimuli being chemical stimuli, and electro-magnetic stimuli. Some examples of tissue which can be produced include other ligaments in the body (hand, wrist, elbow, knee), tendon, cartilage, bone, muscle, and blood vessels.

  4. Effects of tourniquet use in anterior cruciate ligament reconstruction

    Microsoft Academic Search

    Dale M. Daniel; Gerard Lumkong; Mary Lou Stone; Robert A. Pedowitz

    1995-01-01

    Although tourniquets are used commonly during anterior cruciate ligament (ACL) surgery, little data are available regarding their effects on postoperative function. This retrospective study evaluated 94 patients who had an arthroscopically assisted, autogenous bone-patellar ligament-bone ACL reconstruction between 1988 and 1991 at the San Diego Kaiser Hospital. A tourniquet was used in 48 patients (T+ group). No tourniquet was used

  5. Gait and electromyographic analysis of anterior cruciate ligament deficient subjects

    Microsoft Academic Search

    D. J. Beard; R. S. Soundarapandian; J. J. O'Connor; C. A. F. Dodd

    1996-01-01

    Some anterior cruciate ligament deficient (ACLD) patients can overcome passive sagittal joint laxity and maintain dynamic stability of the knee joint. Gait analysis with electromyographic (EMG) support was used in an attempt to identify mechanisms whereby ACLD individuals achieve this functional stability. A group of 18 patients with arthroscopically proven, unilateral, chronic (>6 months) ACLD had their gait assessed using

  6. Epidemiology of Anterior Cruciate Ligament Injuries in Soccer

    Microsoft Academic Search

    Jan M. Bjordal; Frode Arnøy; Birte Hannestad; Torbjørn Strand

    1997-01-01

    We did a retrospective study of all anterior cruciate ligament injuries (972) verified by arthroscopic evalu ation at hospitals in the Hordaland region of Norway from 1982 to 1991. Our final study group comprised 176 patients who had participated in organized soccer and answered a questionnaire. The overall incidence rate was 0.063 injuries per 1000 game hours. Men incurred 75.6%

  7. Anterior cruciate ligament (ACL) injury - aftercare

    MedlinePLUS

    ... of tissue that connects bone to bone. The anterior cruciate ligament (ACL) is located inside your knee joint and ... Amy E, Micheo W. Anterior cruciate ligament tear. In: Frontera WR, ... of Physical Medicine and Rehabilitation . 2nd ed. St. Louis, ...

  8. Complications of anterior cruciate ligament reconstruction: graft issues.

    PubMed

    Matava, Matthew J

    2006-01-01

    Anterior cruciate ligament reconstruction has become one of the most common arthroscopic procedures performed on the knee. Complications from this reconstructive surgery, although uncommon, can be devastating to the overall function of the knee. Several strategies exist to avoid potential complications related specifically to graft harvest and implantation, and to complications related to the bone-patellar tendon-bone and hamstring autografts, and patellar tendon allograft, the most common grafts currently used. PMID:16958483

  9. Reconstruction of the anterior cruciate ligament with quadriceps tendon

    Microsoft Academic Search

    José Carlos Noronha

    2002-01-01

    The author describes the technique he uses to reconstruct the anterior cruciate ligament (ACL) arthroscopically with autologous bone–quadriceps tendon (BQT) graft. The patellar bone is fixed in a femoral tunnel about 2.5 cm long, in a position that allows the tendinous extremity of the graft to appear on the extra-articular exit of the tibial tunnel. The tibial tunnel is filled,

  10. Current trends in anterior cruciate ligament reconstruction.

    PubMed

    Duquin, Thomas R; Wind, William M; Fineberg, Marc S; Smolinski, Robert J; Buyea, Cathy M

    2009-01-01

    In 2006, a survey regarding anterior cruciate ligament (ACL) reconstruction was mailed to physician members of the American Orthopaedic Society for Sports Medicine. A total of 993 responses were received from 1747 possible respondents (57%). The number of ACL reconstructions per year ranged from 1 to 275 (mean=55). The most important factors in the timing of surgery were knee range of motion and effusion. Bone-patellar tendon-bone (BPTB) autograft was most commonly preferred (46%), followed by hamstring tendon autograft (32%) and allografts (22%). Five years earlier, BPTB grafts were more frequent and hamstring tendon and allografts were less frequent (63%, 25%, and 12%, respectively). A single-incision arthroscopic technique was used by 90%. Most allowed return to full activity at 5 to 6 months, with a trend toward earlier return for BPTB grafts; quadriceps strength was an important factor in the decision. There was limited experience (4%) with double-bundle and computer-assisted ACL reconstruction. Arthroscopic-assisted, single-incision reconstruction using a BPTB autograft fixed with metal interference screws remains the most common technique used for primary ACL reconstruction. In the past 5 years, the use of alternative graft sources and methods of fixation has increased. Consensus regarding the best graft type, fixation method, and postoperative protocol is still lacking. PMID:19216345

  11. Anterior cruciate ligament reconstruction in adolescents with open physes.

    PubMed

    Aronowitz, E R; Ganley, T J; Goode, J R; Gregg, J R; Meyer, J S

    2000-01-01

    The purpose of this study was to evaluate anterior cruciate ligament reconstructions performed in adolescents with open physes and a skeletal age of at least 14 years. At one center, from 1992 to 1996, 19 adolescents (ages, 11 to 15 years) with open physes and a skeletal age of at least 14 years underwent arthroscopic anterior cruciate ligament reconstruction using an Achilles tendon allograft placed through drill holes across the open physes in both the distal femur and proximal tibia. Fifteen patients returned for reevaluation at an average of 25 months postoperatively (range, 12 to 60 months); the remaining four patients were interviewed by telephone. There were no significant leg-length discrepancies or angular deformities as determined by scanograms and anteroposterior and lateral radiographs of the femur and tibia. The mean Lysholm knee score was 97 (range, 94 to 100) and the mean KT-1000 arthrometer side-to-side difference at 20 pounds of anterior force was 1.7 mm (range, 0.0 to 3.0). All patients were satisfied with the results of surgery, and 16 of 19 patients returned to the same sport they were participating in before the injury. This study demonstrates that anterior cruciate ligament reconstruction using an Achilles tendon allograft is a viable treatment option for skeletally immature patients with a skeletal age of 14 years who have sustained midsubstance tears of the anterior cruciate ligament. PMID:10750992

  12. Single Femoral Socket Double-Bundle Anterior Cruciate Ligament Reconstruction Using Tibialis Anterior Tendon: Description of a New Technique

    Microsoft Academic Search

    David N. M. Caborn; Haw Chong Chang

    2005-01-01

    The native anterior cruciate ligament (ACL) has been shown to consist of 2 functional bundles with independent behavior throughout range of knee motion. Conventional arthroscopic ACL reconstruction techniques selectively recreate the anteromedial bundle of the native ACL only. Numerous studies have reported the failure to restore normal knee kinematics in an ACL-deficient knee using a single-bundle reconstruction. It has been

  13. Arthroscopic anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft or autograft. A prospective study with an average follow up of 4 years.

    PubMed

    Kleipool, A E; Zijl, J A; Willems, W J

    1998-01-01

    A prospective study was performed with 36 patients who underwent an anterior cruciate ligament (ACL) reconstruction with the use of a fresh-frozen bone-patellar tendon-bone (BPTB) allograft. A group of 26 patients who underwent the same operation conducted by the same surgeon in the same period but with the use of an autograft BPTB served as controls. The average follow-up was 46 (range 30-64) months in the allograft group and 52 (range 42-74) months in the autograft group. The allograft group consisted of 17 men and 19 women with a mean age of 28 years (mean trauma to reconstruction interval was 55 months). The autograft group consisted of 9 men and 17 women with a mean age of 28 years (mean trauma to reconstruction interval was 30 months). Clinical and functional evaluation was performed according to the IKDC guidelines. Analysis of tibial tunnel placement with respect to the Blumenstaat line on a lateral radiograph with the knee in hyperextension was done in relation to an extension deficit and clinical score. In the autograft group 18 (70%) patients had a normal or nearly normal knee and 8, a fair result. In the allograft group 30 (85%) patients had a normal or nearly normal knee, 5 (13%) patients had a fair result, and one (2%) knee was poor. The difference between the two groups was not significant. The allograft BPTB is a good alternative graft in ACL reconstruction. PMID:9826804

  14. Revascularization and ligamentization of autogenous anterior cruciate ligament grafts in humans

    Microsoft Academic Search

    RP Falconiero; VJ DiStefano; TM Cook

    1998-01-01

    Forty-eight patients were enrolled in a study to determine the time interval for maturity and remodeling following arthroscopically assisted autogenous anterior cruciate ligament reconstruction (ACLR). Two biopsy specimens, one superficial and one deep, at the same level in the midsubstance of the ACL were obtained. Graft age, time from ACL reconstruction to biopsy, ranged from 3 months to 120 months.

  15. Clinical outcomes of second-look arthroscopic evaluation after anterior cruciate ligament augmentation: comparison with single- and double-bundle reconstruction.

    PubMed

    Nakamae, A; Ochi, M; Deie, M; Adachi, N; Shibuya, H; Ohkawa, S; Hirata, K

    2014-10-01

    We report the clinical outcome and findings at second-look arthroscopy of 216 patients (mean age 25 years (11 to 58)) who underwent anterior cruciate ligament (ACL) reconstruction or augmentation. There were 73 single-bundle ACL augmentations (44 female, 29 male), 82 double-bundle ACL reconstructions (35 female, 47 male), and 61 single-bundle ACL reconstructions (34 female, 27 male). In 94 of the 216 patients, proprioceptive function of the knee was evaluated before and 12 months after surgery using the threshold to detect passive motion test. Second-look arthroscopy showed significantly better synovial coverage of the graft in the augmentation group (good: 60 (82%), fair: 10 (14%), poor: 3 (4%)) than in the other groups (p = 0.039). The mean side-to-side difference measured with a KT-2000 arthrometer was 0.4 mm (-3.3 to 2.9) in the augmentation group, 0.9 mm (-3.2 to 3.5) in the double-bundle group, and 1.3 mm (-2.7 to 3.9) in the single-bundle group: the result differed significantly between the augmentation and single-bundle groups (p = 0 .013). No significant difference in the Lysholm score or pivot-shift test was seen between the three groups (p = 0.09 and 0.65, respectively). In patients with good synovial coverage, three of the four measurements used revealed significant improvement in proprioceptive function (p = 0.177, 0.020, 0.034, and 0.026). We conclude that ACL augmentation is a reasonable treatment option for patients with favourable ACL remnants. PMID:25274916

  16. Anatomic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Murawski, Christopher D.; Wolf, Megan R.; Araki, Daisuke; Muller, Bart; Tashman, Scott

    2013-01-01

    Anatomic anterior cruciate ligament (ACL) reconstruction is common procedure performed by orthopedic surgeons, particularly in association with sports-related injuries. Whereas traditional reconstruction techniques used a single bundle graft that was typically placed in a non-anatomic position, a renewed interest in anatomy has facilitated the popularization of anatomic reconstruction techniques. Recently, a focus has been placed on individualizing ACL surgery based on each patient’s native anatomical characteristics (e.g., insertion site size, notch size, and shape), thereby dictating the ultimate procedure of choice. As subjective outcome measurements have demonstrated varying outcomes with respect to single- versus double-bundle ACL reconstruction, investigators have turned to more objective techniques, such as in vivo kinematics, as a means of evaluating joint motion and cartilage contact mechanics. Further investigation in this area may yield important information with regard to the potential progression to osteoarthritis after ACL reconstruction, including factors affecting or preventing it.

  17. Failure of anterior cruciate ligament reconstruction.

    PubMed

    Whitehead, Timothy S

    2013-01-01

    Failure after anterior cruciate ligament reconstruction is a potentially devastating event that affects a predominantly young and active population. This review article provides a comprehensive analysis of the potential causes of failure, including graft failure, loss of motion, extensor mechanism dysfunction, osteoarthritis, and infection. The etiology of graft failure is discussed in detail with a particular emphasis on failure after anatomic anterior cruciate ligament reconstruction. PMID:23177471

  18. Histologic findings of anterior cruciate ligament reconstruction with Achilles allograft.

    PubMed

    Chun, Churl Hong; Han, Hong Jun; Lee, Byoung Chang; Kim, Dong Chul; Yang, Jae Hyun

    2004-04-01

    The purpose of the current study was to evaluate the remodeling process of Achilles allograft for anterior cruciate ligament reconstruction under light microscopic and electron microscopic evaluations. In 12 patients, histologic examinations were done preoperatively and during arthroscopy at 6, 12, and 24 months. Gross observations were made with respect to width, vascularity, elasticity, and stability of the Achilles allograft. Biopsy specimens were obtained at the followup arthroscopic study. Light microscopic examinations done at 6 months showed many fibroblasts with spindle-shaped nuclei and hypercellularity. At 12 months, the small folds pattern of collagen bundles and decreased cellularity were observed. At 24 months, gross and findings of the light microscopic evaluations of the allograft tendons were similar to those of the normal anterior cruciate ligaments. On electron microscopic examinations done at 24 months, the allograft had fibroblasts with much cytoplasm and densely packed parallel-laid collagen fibrils, which showed the characteristic cross striations, but the Achilles allograft ligaments did not show similar findings compared with biopsy samples from normal anterior cruciate ligaments. PMID:15123959

  19. Anterior Cruciate Ligament Graft Choices

    PubMed Central

    Macaulay, Alec A.; Perfetti, Dean C.; Levine, William N.

    2012-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is a common surgical procedure; however, there is no consensus to what the best graft option is to replace the injured ACL. The main options available consist of allografts and autografts, which include patellar tendon, hamstring tendon, and quadriceps tendon autografts. Evidence Acquisition: The PubMed database was searched in August 2010 for English-language articles pertaining to ACL grafts. Results: Postoperative outcome variables were analyzed to determine similarities and differences among the different graft options. These variables include stability, strength, function, return to sports, patient satisfaction, complications, and cost. Conclusions: Both allografts and the 3 main options for autografts can provide excellent results in ACL reconstruction and lead to a high percentage of satisfied patients. However, differences exist among the graft choices. Both the similarities and the differences are important to discuss with a patient who will be undergoing ACL reconstruction so that he or she has the best information available when making a choice of graft. PMID:23016071

  20. Arthroscopic reconstruction of the posterior cruciate ligament

    Microsoft Academic Search

    Chih-Hwa Chen; Wen-Jer Chen; Chun-Hsiung Shih

    2002-01-01

    Purpose: Considerable controversies remain on the graft choice and fixation methods in the posterior cruciate ligament (PCL) reconstruction. The purpose of this study was to compare, at minimal 2-year follow-up, the outcomes of PCL reconstruction between using quadriceps tendon autograft and using quadruple hamstring tendon autograft. Type of Study: Case series. Methods: All patients received only PCL reconstruction without combined

  1. Longitudinal anterior knee laxity related to substantial tibial tunnel enlargement after anterior cruciate ligament revision.

    PubMed

    Quatman, Carmen E; Paterno, Mark V; Wordeman, Samuel C; Kaeding, Christopher C

    2011-08-01

    Allograft and bioabsorbable screw use in anterior cruciate ligament (ACL) revision surgery is common. However, both allograft and bioabsorbable screws have been associated with immunologic reactions that lead to tunnel enlargement. Long-term studies examining tibial tunnel enlargement in this population are currently not available. We report a case of severe tibial and femoral tunnel enlargement 6.5 years after ACL revision surgery with anterior tibialis and semitendinosus allograft and bioabsorbable screw fixation. Longitudinal knee arthrometer data, knee examination with the patient under anesthesia, and arthroscopic inspection of the graft showed minimal effects of severe tunnel enlargement on anterior knee laxity and graft integrity. To our knowledge, this is the first case report of a longitudinal assessment of anterior knee laxity associated with severe tunnel enlargement. Surgeons should be aware of this condition and the clinical consequences that may accompany bone tunnel enlargement after ACL surgery. PMID:21802626

  2. Anatomical single bundle anterior cruciate ligament reconstruction

    Microsoft Academic Search

    Michael R. Carmont; Sven Scheffler; Tim Spalding; Jeremy Brown; Paul M. Sutton

    2011-01-01

    We present a review of the literature looking at the anatomy of the Anterior Cruciate Ligament, the biomechanical aspects\\u000a of ACL reconstruction, review the outcomes of single and double bundle ACL reconstruction and present the current techniques\\u000a for anatomic single bundle reconstruction.

  3. The O'Donoghue triad revisitedCombined knee injuries involving anterior cruciate and medial collateral ligament tears

    Microsoft Academic Search

    K. Donald Shelbourne; Paul A. Nitz

    1991-01-01

    We identified 60 consecutive patients with combined anterior cruciate and medial collateral ligament (ACL- MCL) disruptions that were incurred during athletic endeavors. Each underwent acute reconstruction of the ACL. The arthroscopic data obtained at the time of reconstructive surgery was reviewed in order to deter mine the incidence of O'Donoghue's triad (the \\

  4. All-inside patellar tendon anterior cruciate ligament reconstruction.

    PubMed

    Bradley, James P; Tejwani, Samir G

    2009-12-01

    In the continued evolution of arthroscopic surgery for anterior cruciate ligament (ACL) reconstruction, the "All-Inside" technique has been developed in an attempt to further decrease surgical trauma. By replicating standard anatomic ACL reconstruction techniques, the RetroConstruction System (Arthrex, Naples, FL) eliminates tibial tunnels by creating "Retrodrilled" sockets. This All-Inside technique reduces the size and number of incisions and associated soft-tissue trauma, while eliminating the violation of distal cortices, thereby potentially decreasing patient morbidity, facilitating rehabilitation, and improving cosmesis. The technique is suitable for numerous graft options and can be used either in primary, revision augmentation, or multiligament reconstructions. The rationale and technique for All-Inside bone-patellar tendon-bone autograft or allograft single-bundle ACL reconstruction is presented. PMID:19910784

  5. Anatomical double-bundle anterior cruciate ligament reconstruction.

    PubMed

    Zelle, Boris A; Brucker, Peter U; Feng, Matthew T; Fu, Freddie H

    2006-01-01

    A careful review of the literature suggests that a significant number of patients undergoing anterior cruciate ligament (ACL) reconstruction have less than optimal results. Although overall outcomes of ACL reconstruction are favourable, there remains considerable room for improvement. Anatomically, the ACL consists of two major functional bundles, the anteromedial and the posterolateral bundle. Biomechanically, both bundles contribute significantly to the anterior and the rotational stability of the knee. Therefore, anatomical double-bundle ACL reconstruction techniques may further improve the outcomes in ACL surgery. Our preferred technique for arthroscopic double-bundle ACL reconstruction includes the use of two femoral and two tibial tunnels to restore both the anteromedial and the posterolateral bundle of the ACL and their anatomical footprints at their tibial and femoral insertion site. We use two tibialis anterior tendon allografts for the restoration of the two ACL bundles. Clinical long-term outcome studies may focus on the evaluation of functional outcomes, restoration of anterior and rotational knee stability, and the risk of degenerative osteoarthritis of the knee joint following anatomical double-bundle ACL reconstruction versus single-bundle ACL reconstruction. PMID:16464119

  6. [Infection after anterior cruciate ligament reconstruction: grave error in treatment?].

    PubMed

    Regauer, M; Neu, J

    2012-09-01

    A 28-year-old patient showed clear signs of knee joint infection 8 days after arthroscopic reconstruction of the anterior cruciate ligament. The treating physicians recommended further observation although they stated that a knee joint infection could not be reliably excluded. One week later arthroscopic revision was performed and intraoperative smear tests showed infection by Pseudomonas aeruginosa. Therefore, another 6 days later the obviously infected transplant had to be removed. In the long run painful and limited range of motion of the affected knee joint persisted. The patient complained about medical malpractice concerning management of the complication. The expert opinion stated that due to the fateful course of infection the tendon graft could not be retrieved after the eighth day post surgery anyway. Thus, only flawed delay of treatment was criticized. The arbitration board argued, however, that scientific data concerning the fate of infected tendon grafts do not support the expert opinion and that immediate arthroscopy and antibiotic treatment at least had the potential to influence the course of infection in a positive manner. Evidence clearly shows that survival of an infected tendon graft depends on early diagnosis and emergency treatment rather than just on fate. Due to the fact that, although having in mind the possibility of a knee joint infection, the necessary therapy was delayed for 8 days, the arbitration board considered the described medical malpractice a severe treatment error, leading to reversal of evidence in favour of the patient. PMID:22706649

  7. Anatomic anterior cruciate ligament reconstruction: a changing paradigm.

    PubMed

    Fu, Freddie H; van Eck, Carola F; Tashman, Scott; Irrgang, James J; Moreland, Morey S

    2015-03-01

    Injury to the anterior cruciate ligament (ACL) of the knee is potentially devastating for the patient and can result in both acute and long-term clinical problems. Consequently, the ACL has always been and continues to be of great interest to orthopaedic scientists and clinicians worldwide. Major advancements in ACL surgery have been made in the past few years. ACL reconstruction has shifted from an open to arthroscopic procedure, in which a two- and later one-incision technique was applied. Studies have found that traditional, transtibial arthroscopic single-bundle reconstruction does not fully restore rotational stability of the knee joint, and as such, a more anatomic approach to ACL reconstruction has emerged. The goal of anatomic ACL reconstruction is to replicate the knee's normal anatomy and restore its normal kinematics, all while protecting long-term knee health. This manuscript describes the research that has changed the paradigm of ACL reconstruction from traditional techniques to present day anatomic and individualized concepts. PMID:25086574

  8. Anterior Cruciate Ligament Strain Behavior During Rehabilitation Exercises In Vivo

    Microsoft Academic Search

    Bruce D. Beynnon; Braden C. Fleming; Robert J. Johnson; Claude E. Nichols; Per A. Renström; Malcolm H. Pope

    1995-01-01

    Before studying the biomechanical effects of rehabili tation exercises on the reconstructed knee, it is impor tant to understand their effects on the normal anterior cruciate ligament. The objective of this investigation was to measure the strain behavior of this ligament dur ing rehabilitation activities in vivo. Participants were pa tient volunteers with normal anterior cruciate ligaments instrumented with the

  9. Anterior cruciate ligament reconstruction in patients older than 35 years.

    PubMed

    El-Sallakh, Sameh; Pastides, Philip; Thomas, Panos

    2014-12-01

    Anterior cruciate ligament (ACL) reconstruction is an increasingly established method even in patients older than 35 years. Our hypothesis is that functional outcome after ACL reconstruction is comparable in patients younger and older than 35 years. A total of 28 patients (5 women and 23 men) with average age of 41.5 years (36-68) were retrospectively evaluated. The average follow-up period was 33 months. All of them were treated operatively with arthroscopic single-bundle four-strand hamstring tendon autograft. The functional outcome was determined by clinical scores (Tegner activity scale and Lysholm knee score). The median values for the Lysholm knee score were preoperatively 77 and postoperatively 96 points (range, 90-100) with significant improvement (p?anterior knee instability. We commonly propose surgical treatment in symptomatic patients who express the need to restore their preinjury activity levels, regardless of their age. PMID:24510521

  10. Arthroscopic posterior cruciate ligament reconstruction with allograft versus autograft

    PubMed Central

    Sun, Xiujiang; Zhang, Jianfeng; Qu, Xiaoyi

    2015-01-01

    Introduction The aim of the study was to compare and analyze retrospectively the outcomes of arthroscopic posterior cruciate ligament reconstruction with autograft versus allograft. Material and methods Seventy-one patients who underwent arthroscopic posterior cruciate ligament reconstruction with an autograft or allograft met our inclusion criteria. There were 36 patients in the autograft group and 35 patients in the allograft group. All the patients were evaluated by physical examination and a functional ligament test. Comparative analysis was done in terms of operation time, incision length, fever time, postoperative infection rate, incidence of numbness and dysesthesia around the incision, as well as a routine blood test. Results The average follow-up of the autograft group was 3.2 ±0.2 years and that of the allograft group was 3.3 ±0.6 years; there was no significant difference (p > 0.05). No differences existed in knee range of motion, Lysholm scores, International Knee Documentation Committee standard evaluation form and Tegner activity score at final follow-up (p > 0.05), except that patients in the allograft group had a shorter operation time and incision length and a longer fever time (p < 0.05). We found a difference in posterior drawer test and KT-2000 arthrometer assessment (p < 0.05). The posterior tibia displacement averaged 3.8 ±1.5 mm in the autograft group and 4.8 ±1.7 mm in the allograft group (p < 0.05). The incidence of numbness and dysesthesia around the incision in the autograft group was higher than that in the allograft group (p < 0.05). There was no infection postoperatively. The white blood cells and neutrophils in the allograft group increased more than those in the autograft group postoperatively (p < 0.05). Conclusions Both groups of patients had satisfactory outcomes after the operation. However, in the instrumented posterior laxity test, the autograft gave better results than the allograft. No differences in functional scores were found. PMID:25995757

  11. Anterior cruciate ligament reconstruction in the young patient without violation of the epiphyseal plate.

    PubMed

    Kim, S H; Ha, K I; Ahn, J H; Chang, D K

    1999-10-01

    A technique of arthroscopic anterior cruciate ligament reconstruction that does not disturb the epiphyseal plate in the young patient with open physis is presented. A cryopreserved bone-Achilles tendon allograft was incorporated by an interference screw fixation to the bone plug in the tibia and an over-the-top positioning of the tendon on the femoral side. For this procedure, the minimal patient age that the thickness of the epiphysis can accept an interference screw greater than 15 mm in length is 8 years. An intra-articular reconstruction of anterior cruciate ligament with the cryopreserved Achilles allograft using our technique is safe and recommendable for young patients with open physis. PMID:10524833

  12. Arthroscopic double-bundled posterior cruciate ligament reconstruction with quadriceps tendon–patellar bone autograft

    Microsoft Academic Search

    Chih-Hwa Chen; Wen-Jer Chen; Chun-Hsiung Shih

    2000-01-01

    Summary: An arthroscopic technique for double-bundled reconstruction for posterior cruciate ligament with quadriceps tendon–patellar bone autograft is presented. Anterolateral and posteromedial tunnels were created to simulate and reproduce the double-bundle structure of the posterior cruciate ligament. The bone plug is situated at the tibial tunnel and fixed by a titanium interference screw. Each of the bundles of tendon graft is

  13. Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

    PubMed

    Koyonos, Loukas; Owsley, Kevin; Vollmer, Emily; Limpisvasti, Orr; Gambardella, Ralph

    2014-12-01

    Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p?

  14. Anterior Cruciate Ligament Reconstruction With LARS Artificial Ligament: A Multicenter Study With 3- to 5Year Follow-up

    Microsoft Academic Search

    Kai Gao; Shiyi Chen; Lide Wang; Weiguo Zhang; Yifan Kang; Qirong Dong; Haibin Zhou; Linan Li

    2010-01-01

    Purpose: The aim of this multicenter study was to evaluate the clinical outcome of anterior cruciate ligament (ACL) reconstruction by use of the Ligament Advanced Reinforcement System (LARS) artificial ligament (Surgical Implants and Devices, Arc-sur-Tille, France) with 3- to 5-year follow-up. Methods: From August 2004 to July 2006, 159 patients with ACL rupture underwent arthroscopic ACL recon- struction with LARS

  15. Posterior cruciate ligament reconstruction with a single-sling technique using a tibialis anterior tendon allograft.

    PubMed

    Jin, Cheng Zhe; Roh, Jeong Ho; Min, Byoung-Hyun

    2007-03-01

    Reconstruction of the posterior cruciate ligament (PCL) has been performed in various ways. Recent biomechanical tests revealed that a double-bundle graft with a 2-tunnel technique is more likely to restore normal knee stability throughout the full range of knee motion. Several techniques using double-bundle grafts have been implemented for PCL reconstruction; however, each technique has its own advantages and disadvantages. To provide a simplified surgical technique and minimize its inherent complications, the purpose of this study was to introduce a novel technique of arthroscopic PCL reconstruction using an allogeneic tibialis anterior tendon and forming a single sling. PMID:17349480

  16. Repairable posterior menisco-capsular disruption in anterior cruciate ligament injuries.

    PubMed

    Woods, G W; Chapman, D R

    1984-01-01

    Two hundred thirty-four consecutive patients with a positive Lachman test underwent examination under anesthesia and diagnostic arthroscopy to include complete evaluation of both posterior menisco-capsular attachments. Knees which had had previous arthrotomy were excluded. Complete repairable posterior menisco-capsular disruptions occurred in 31 of 112 (27.7%) acute cases and 36 of 122 (29.5%) knees in the chronic group. These lesions are not predictable by physical examination or by routine clinical grading of instability. Thorough arthroscopic examination to include direct visualization of the posterior menisco-capsular junction is necessary for complete diagnosis in anterior cruciate ligament injuries. PMID:6548611

  17. Current Trends in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kim, Ha Sung; Jo, Ah Reum

    2013-01-01

    The advances in the knowledge of anatomy, surgical techniques, and fixation devices have led to the improvement of anterior cruciate ligament (ACL) reconstruction over the past 10 years. Nowadays, double bundle and anatomical single bundle ACL reconstruction that more closely restores the normal anatomy of the ACL are becoming popular. Although there is still no definite conclusion whether double bundle ACL reconstruction provides better clinical results than single bundle reconstruction, the trend has shifted to anatomic reconstruction regardless of single bundle or double bundle techniques. We could not find any significant differences in the clinical outcomes and stability after ACL reconstruction according to the type of graft or fixation device. Therefore, surgeons should select an ideal ACL reconstruction according to the patient's condition and surgeon's experience. PMID:24368993

  18. Individualized anatomic anterior cruciate ligament reconstruction.

    PubMed

    van Eck, Carola F; Widhalm, Harrald; Murawski, Christopher; Fu, Freddie H

    2015-02-01

    Abstract Anterior cruciate ligament (ACL) injuries are often seen in young participants in sports such as soccer, football, and basketball. Treatment options include conservative management as well as surgical intervention, with the goal of enabling the patient to return to cutting and pivoting sports and activities. Individualized anatomic ACL reconstruction is a surgical technique that tailors the procedure to the individual patient using preoperative measurements on plain radiographs and magnetic resonance imaging and intraoperative measurement to map the patients' native ACL anatomy in order to replicate it as closely as possible. Anatomic ACL reconstruction, therefore, is defined as reconstruction of the ACL to its native dimensions, collagen orientation, and insertion site. The surgical reconstruction is followed by a specific rehabilitation protocol that is designed to enable the patient to regain muscle strength and proprioception while facilitating healing of the reconstructed ACL prior to the patient's returning to sports activities. PMID:25684559

  19. Design of a novel anterior cruciate ligament prosthesis

    E-print Network

    Talei Franzesi, Giovanni

    2006-01-01

    Injuries to the anterior cruciate ligament (ACL) are extremely common (approximately 100,000 every year in the US) and result in greatly reduced mobility; although several surgical procedures have been devised to address ...

  20. The 5-strand hamstring graft in anterior cruciate ligament reconstruction.

    PubMed

    Lee, Rushyuan Jay; Ganley, Theodore J

    2014-10-01

    The use of anterior cruciate ligament reconstruction in the pediatric and adolescent population has been increasing in recent years. Autograft hamstring graft is favored in this population, but these patients often have smaller hamstring tendons that yield smaller final graft constructs. These smaller grafts are associated with an increased need for revision surgery. We describe a technique for obtaining a larger-diameter anterior cruciate ligament graft construct from autologous hamstring graft without allograft supplementation. PMID:25473619

  1. Arthroscopic Bone Graft Procedure for Anterior Inferior Glenohumeral Instability

    PubMed Central

    Taverna, Ettore; D'Ambrosi, Riccardo; Perfetti, Carlo; Garavaglia, Guido

    2014-01-01

    There are many described surgical techniques for the treatment of recurrent anterior shoulder instability. Numerous authors have performed anterior bone block procedures with good results for the treatment of anterior shoulder instability with glenoid bone loss. The benefits of using arthroscopic procedures for surgical stabilization of the shoulder include smaller incisions with less soft-tissue dissection, better visualization of the joint, better repair accessibility, and the best possible outcome for external rotation. We describe an arthroscopic anteroinferior shoulder stabilization technique with an iliac crest tricortical bone graft and capsulolabral reconstruction. It is an all-arthroscopic technique with the advantage of not using fixation devices, such as screws, but instead using special buttons to fix the bone graft. The steps of the operation are as follows: precise placement of a specific posterior glenoid guide that allows the accurate positioning of the bone graft on the anterior glenoid neck; fixation of the graft flush with the anterior glenoid rim using specific buttons under arthroscopic control; and finally, subsequent capsular, labral, and ligament reconstruction on the glenoid rim using suture anchors and leaving the graft as an extra-articular structure. PMID:25685669

  2. Arthroscopic anterior cruciate ligament surgery: results of autogenous patellar tendon graft versus the Leeds-Keio synthetic graft five year follow-up of a prospective randomised controlled trial.

    PubMed

    Ghalayini, S R A; Helm, A T; Bonshahi, A Y; Lavender, A; Johnson, D S; Smith, R B

    2010-10-01

    We conducted a prospective, randomised controlled trial comparing anterior cruciate ligament reconstruction using middle third patellar tendon graft (PT) to synthetic Leeds-Keio (LK) ligament. The patients were randomised (26 PT, 24 LK). Subjective knee function was classified (Lysholm, Tegner activity, IKDC scores), laxity was measured (Lachman test, Stryker laxometer), and functional ability was assessed (one-hop test). There were no significant differences between Lysholm or IKDC scores at any stage by 5 years. Significant differences were found between the groups at 2 years for Tegner activity scores, laxity and one-hop testing. By 5 years there were no significant differences. Clinical equivalence was demonstrated between the two groups for the Lysholm score and one-hop test but not for the Tegner activity score at 5 years. The use of the LK ligament has been largely abandoned due to reports of its insufficiency. Our results demonstrate that it is not as inferior as one might expect. We conclude that the results of LK ligament ACL reconstruction are as acceptable as those using PT. It may provide an additional means of reconstruction where no suitable alternative is present. PMID:19861236

  3. Arthroscopic transglenoid suture repair for initial anterior shoulder dislocation

    Microsoft Academic Search

    Harald Boszotta; Walther Helperstorfer

    2000-01-01

    Purpose: To evaluate the long-term results after arthroscopic transglenoid suture repair for initial anterior shoulder dislocation. Type of Study: Outcome study. Materials and Methods: Selection for surgery was based on the sporting ambitions of the patients and the documentation of instability. Evidence of instability included the sonographic documentation of ventral drawer compared with the unaffected opposite shoulder as well as

  4. Achilles tendon allograft reconstruction of the anterior cruciate ligament-deficient knee.

    PubMed

    Linn, R M; Fischer, D A; Smith, J P; Burstein, D B; Quick, D C

    1993-01-01

    Thirty-five patients had reconstruction of the anterior cruciate ligament with intraarticular fresh-frozen Achilles tendon allograft and extraarticular tibial band tenodesis. Patients were followed 2 to 4 years (mean, 2.5). Evaluation included clinical and functional examinations, measurement of tibiofemoral displacement, and anteroposterior and lateral radiographs. Clinical results were considered satisfactory in 85% of the patients; 16 had arthroscopic examination after the allograft; allograft biopsies in 9 at this time showed cellular and vascular tissue without evidence of immune reaction. Clinical, arthroscopic, and biopsy results were favorable, but radiologic results were not. In most patients there was a significant size increase in femoral and tibial bone tunnels, as measured from radiographs. In the 6 most extreme cases, bone tunnels measured 20 mm or more in diameter, twice the initial size. Etiology and clinical significance of these bone tunnel changes remain unknown. Enlargement appears to occur early after operation; it stabilizes within 2 years. No statistical correlation was seen between tunnel enlargement and results of clinical and functional examinations; nevertheless, unexplained tunnel enlargement is cause for concern, and allograft replacement of the anterior cruciate ligament with fresh-frozen Achilles tendon allograft should be considered a salvage procedure. PMID:8291633

  5. Single femoral socket double-bundle anterior cruciate ligament reconstruction using tibialis anterior tendon: description of a new technique.

    PubMed

    Caborn, David N M; Chang, Haw Chong

    2005-10-01

    The native anterior cruciate ligament (ACL) has been shown to consist of 2 functional bundles with independent behavior throughout range of knee motion. Conventional arthroscopic ACL reconstruction techniques selectively recreate the anteromedial bundle of the native ACL only. Numerous studies have reported the failure to restore normal knee kinematics in an ACL-deficient knee using a single-bundle reconstruction. It has been suggested that by reconstructing both the anteromedial and posterolateral bundles of the ACL, more normal knee kinematics may be achieved. Several authors have described surgical techniques to recreate the 2 functional bundles and they range from using 2 femoral tunnels to using a single femoral tunnel with the other bundle passed over the top. This article describes a new technique of recreating the 2 functional bundles of the ACL with tibialis anterior tendon allograft using a single femoral socket. PMID:16226664

  6. Guideline on anterior cruciate ligament injury

    PubMed Central

    2012-01-01

    The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association. What is the role of physical examination and additional diagnostic tools? Which patient-related outcome measures should be used? What are the relevant parameters that influence the indication for an ACL reconstruction? Which findings or complaints are predictive of a bad result of an ACL injury treatment? What is the optimal timing for surgery for an ACL injury? What is the outcome of different conservative treatment modalities? Which kind of graft gives the best result in an ACL reconstruction? What is the optimal postoperative treatment concerning rehabilitation, resumption of sports, and physiotherapy? These 8 questions were answered and recommendations were made, using the “Appraisal of Guidelines for Research and Evaluation” instrument. This instrument seeks to improve the quality and effectiveness of clinical practical guidelines by establishing a shared framework to develop, report, and assess. The steering group has also developed 7 internal indicators to aid in measuring and enhancing the quality of the treatment of patients with an ACL injury, for use in a hospital or practice. PMID:22900914

  7. Principles of postoperative anterior cruciate ligament rehabilitation

    PubMed Central

    Saka, Tolga

    2014-01-01

    It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, “ossified” knowledge or modalities really prove themselves in the literature? Could questions such as “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?” be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

  8. Principles of postoperative anterior cruciate ligament rehabilitation.

    PubMed

    Saka, Tolga

    2014-09-18

    It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, "ossified" knowledge or modalities really prove themselves in the literature? Could questions such as "is postoperative brace use really necessary?", "what are the benefits of early restoration of the range of motion (ROM)?", "to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?", "how early can proprioception training and open chain exercises begin?", "should strengthening training start in the immediate postoperative period?" be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

  9. Sex comparison of familial predisposition to anterior cruciate ligament injury

    PubMed Central

    Heidt, Robert S.; Waits, Chad; Finck, Samuel; Stanfield, Denver; Posthumus, Michael; Hewett, Timothy E.

    2014-01-01

    Purpose In an effort to identify risk factors for anterior cruciate ligament (ACL) injury, many potential risk factors have been proposed, including familial predisposition. However, no study has evaluated familial predisposition in male or females separately. The purpose of this study was to determine whether a familial predisposition to ACL injury exists in both males and females. Methods One hundred and twenty (78 males and 42 females) patients who had undergone surgical ACL reconstruction were recruited as the ACL group, and 107 patients (67 males and 40 females) that had undergone arthroscopic partial menisectomy, with no previous history of ACL injury, were recruited as the referent control group. A familial ACL injury and subject particulars questionnaire was completed. Results When all subjects were combined, the ACL group (20.0 %, 24 of 120) did not demonstrate a higher familial (first-degree relative) prevalence (n.s.) of ACL injury compared to the referent control group (15.0 %; 16 of 107 patients). When the data were stratified by sex, the male ACL group (19.2 %, 15 of 78) demonstrated a significantly higher familial (first-degree relative) prevalence (P = 0.02) of ACL injury compared to the male referent control group (7.5 %; 5 of 67 patients). There were no differences among the females (n.s.). Discussion The results of this study show that male patients with ACL tears are more likely to have a first-degree relative with an ACL tear compared to male referent control subjects. Future research is warranted to better delineate sex-specific risk factors for ACL injuries could help guide intervention programs aimed at preventative treatment strategies, especially in high-risk families. PMID:24402048

  10. Primary Anatomic Double-Bundle Anterior Cruciate Ligament ReconstructionA Preliminary 2Year Prospective Study

    Microsoft Academic Search

    Freddie H. Fu; Wei Shen; James S. Starman; Nnamdi Okeke; James J. Irrgang

    2008-01-01

    Background: The anterior cruciate ligament consists of 2 functional bundles, the anteromedial bundle and the posterolateral bundle. Single-bundle anterior cruciate ligament reconstruction is the current standard for the treatment of anterior cruciate ligament deficiency. However, a significant subset of patients continues to report residual symptoms of instability after such reconstruction.Hypothesis: Anatomic double-bundle anterior cruciate ligament reconstruction may more closely restore

  11. Arthroscopic Assessment of Stifle Synovitis in Dogs with Cranial Cruciate Ligament Rupture

    PubMed Central

    Little, Jeffrey P.; Bleedorn, Jason A.; Sutherland, Brian J.; Sullivan, Ruth; Kalscheur, Vicki L.; Ramaker, Megan A.; Schaefer, Susan L.; Hao, Zhengling; Muir, Peter

    2014-01-01

    Cranial cruciate ligament rupture (CR) is a degenerative condition in dogs that typically has a non-contact mechanism. Subsequent contralateral rupture often develops in dogs with unilateral CR. Synovitis severity is an important factor that promotes ligament degradation. Consequently, we wished to evaluate the utility of arthroscopy for assessment of stifle synovitis in dogs with CR. Herein, we report results of a prospective study of 27 dogs with unilateral CR and bilateral radiographic osteoarthritis. Arthroscopic images and synovial biopsies from the lateral and medial joint pouches were obtained bilaterally and graded for synovial hypertrophy, vascularity, and synovitis. Synovial tartrate-resistant acid phosphatase-positive (TRAP+) macrophages, CD3+ T lymphocytes, Factor VIII+ blood vessels, and synovial intima thickness were quantified histologically and related to arthroscopic observations. Risk of subsequent contralateral CR was examined using survival analysis. We found that arthroscopic scores were increased in the index stifle, compared with the contralateral stifle (p<0.05). Numbers of CD3+ T lymphocytes (SR?=?0.50, p<0.05) and TRAP+ cells in joint pouches (SR?=?0.59, p<0.01) were correlated between joint pairs. Arthroscopic grading of vascularity and synovitis was correlated with number density of Factor VIII+ vessels (SR>0.34, p<0.05). Arthroscopic grading of villus hypertrophy correlated with numbers of CD3+ T lymphocytes (SR?=?0.34, p<0.05). Synovial intima thickness was correlated with arthroscopic hypertrophy, vascularity, and synovitis (SR>0.31, p<0.05). Strong intra-observer and moderate inter-observer agreement for arthroscopic scoring was found. Dog age and arthroscopic vascularity significantly influenced risk of contralateral CR over time. We conclude that arthroscopic grading of synovitis is a precise tool that correlates with histologic synovitis. Arthroscopy is useful for assessment of stifle synovitis in client-owned dogs, and could be used in longitudinal clinical trials to monitor synovial responses to disease-modifying therapy. PMID:24892866

  12. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH DOUBLE BUNDLE VERSUS SINGLE BUNDLE: EXPERIMENTAL STUDY

    Microsoft Academic Search

    Roberto F. Mota; Sandra Umeda Sasaki; Marco Martins; Fabio Janson Angelini

    2007-01-01

    OBJECTIVE: To test an intra-articular reconstruction of the anterior cruciate ligament of the knee in 10 human cadavers by replacing 2 anterior cruciate ligament bundles, with the purpose of producing a surrogate that would be structurally more similar to the anatomy of the anterior cruciate ligament and would provide the knee with more stability. METHODS: We reconstructed the anteromedial and

  13. Arthroscopic posterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft

    Microsoft Academic Search

    C.-H. Chen; W.-J. Chen; C.-H. Shih

    1999-01-01

    Surgical reconstruction of the posterior cruciate ligament (PCL) is indicated in the PCL-deficient knee with symptomatic\\u000a instability and multiple ligamentous injury. However, the choice of graft tissues continues to be controversial. We describe\\u000a an arthroscopic PCL reconstruction technique using the quadriceps tendon-patellar bone autograft. From March through September\\u000a 1996, this autograft was used in 12 patients with PCL injuries. After

  14. Rehabilitation After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kruse, L.M.; Gray, B.; Wright, R.W.

    2012-01-01

    Background: Rigorous rehabilitation after anterior cruciate ligament (ACL) reconstruction is necessary for a successful surgical outcome. A large number of clinical trials continue to assess aspects of this rehabilitation process. Prior systematic reviews evaluated fifty-four Level-I and II clinical trials published through 2005. Methods: Eighty-five articles from 2006 to 2010 were identified utilizing multiple search engines. Twenty-nine Level-I or II studies met inclusion criteria and were evaluated with use of the CONSORT (Consolidated Standards of Reporting Trials) criteria. Topics included in this review are postoperative bracing, accelerated strengthening, home-based rehabilitation, proprioception and neuromuscular training, and six miscellaneous topics investigated in single trials. Results: Bracing following ACL reconstruction remains neither necessary nor beneficial and adds to the cost of the procedure. Early return to sports needs further research. Home-based rehabilitation can be successful. Although neuromuscular interventions are not likely to be harmful to patients, they are also not likely to yield large improvements in outcomes or help patients return to sports faster. Thus, they should not be performed to the exclusion of strengthening and range-of-motion exercises. Vibration training may lead to faster and more complete proprioceptive recovery but further evidence is needed. Conclusions: Several new modalities for rehabilitation after ACL reconstruction may be helpful but should not be performed to the exclusion of range-of-motion, strengthening, and functional exercises. Accelerated rehabilitation does not appear to be harmful but further investigation of rehabilitation timing is warranted. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:23032584

  15. Anterior Cruciate Ligament Reconstruction and Osteoarthritis

    PubMed Central

    Duthon, Victoria; Servien, Elvire; Neyret, Philippe

    2013-01-01

    Objective: The goals of this study are to address several questions, the answers to which are key to the understanding and eventually to the prevention of this frequent source of morbidity. These questions include the following: (1) What is the natural history of anterior cruciate ligament (ACL) deficiency? (2) How important is the status of the meniscus at the time of reconstruction? (3) Does ACL reconstruction prevent the development of osteoarthritis in the long term? (4) Can we predict which patients will develop osteoarthritis? (5) What can be done? Design: This study addresses the key questions above through the long-term follow-up of a cohort of patients treated with ACL reconstruction by Professor Henri Dejour in Lyon, France, supplemented with a review of the relevant literature. Results: The prevalence of osteoarthritis in ACL-deficient knees is about 40% after 15 years and close to 90% after 25 to 35 years. It remains unclear whether reconstruction of the ACL significantly reduces this risk. The status of the meniscus at the time of ACL reconstruction is a strong predictor of the risk of osteoarthritis: Patients who undergo total meniscectomy are at 2- to 10-fold increased risk of developing osteoarthritis relative to those with intact menisci. Patients showing early evidence of arthritis at short- to medium-term follow-up are at high risk for progression over subsequent years. Numerous emerging techniques may provide tools to more effectively prevent and treat osteoarthritis following ACL injury in the future. Conclusion: Osteoarthritis following ACL injury continues to be a major problem requiring further research.

  16. Factors Associated With Function After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Lentz, Trevor A.; Tillman, Susan M.; Indelicato, Peter A.; Moser, Michael W.; George, Steven Z.; Chmielewski, Terese L.

    2009-01-01

    Background: Many individuals do not resume unrestricted, preinjury sports participation after anterior cruciate ligament reconstruction, thus a better understanding of factors associated with function is needed. The purpose of this study was to investigate the association of knee impairment and psychological variables with function in subjects with anterior cruciate ligament reconstruction. Hypothesis: After controlling for demographic variables, knee impairment and psychological variables contribute to function in subjects with anterior cruciate ligament reconstruction. Study Design: Cross-sectional study; Level of evidence, 4a. Methods: Fifty-eight subjects with a unilateral anterior cruciate ligament reconstruction completed a standardized testing battery for knee impairments (range of motion, effusion, quadriceps strength, anterior knee joint laxity, and pain intensity), kinesiophobia (shortened Tampa Scale for Kinesiophobia), and function (International Knee Documentation Committee subjective form and single-legged hop test). Separate 2-step regression analyses were conducted with International Knee Documentation Committee subjective form score and single-legged hop index as dependent variables. Demographic variables were entered into the model first, followed by knee impairment measures and Tampa Scale for Kinesiophobia score. Results: A combination of pain intensity, quadriceps index, Tampa Scale for Kinesiophobia score, and flexion motion deficit contributed to the International Knee Documentation Committee subjective form score (adjusted r2 = 0.67; P < .001). Only effusion contributed to the single-legged hop index (adjusted r2 = 0.346; P = .002). Conclusion: Knee impairment and psychological variables in this study were associated with self-report of function, not a performance test. Clinical Relevance: The results support focusing anterior cruciate ligament reconstruction rehabilitation on pain, knee motion deficits, and quadriceps strength, as well as indicate that kinesiophobia should be addressed. Further research is needed to reveal which clinical tests are associated with performance testing. PMID:23015854

  17. Downhill walking: A stressful task for the anterior cruciate ligament?

    Microsoft Academic Search

    M. Kuster; G. A. Wood; S. Sakurai; G. Blatter

    1994-01-01

    Accelerated rehabilitation after anterior cruciate ligament (ACL) reconstruction has become increasingly popular. Methods employed include immediate extension of the knee and immediate full weight bearing despite the risks presented by a graft pull-out fixation strength of 200–500 N. The purpose of this study was to calculate the tibiofemoral shear forces and the dynamic stabilising factors at the knee joint for

  18. Nocardia Septic Arthritis Complicating an Anterior Cruciate Ligament Repair.

    PubMed

    Yong, Elaine X L; Cheong, Elaine Y L; Boutlis, Craig S; Chen, Darren B; Liu, Eunice Y-T; McKew, Genevieve L

    2015-08-01

    Nocardia infection following anterior cruciate ligament (ACL) allograft reconstruction is a rare occurrence. We report a case of Nocardia infection of an allograft ACL reconstruction and septic arthritis of the knee joint due to an organism most similar to the novel Nocardia species Nocardia aobensis. PMID:26041900

  19. Silk matrix for tissue engineered anterior cruciate ligaments

    Microsoft Academic Search

    Gregory H Altman; Rebecca L Horan; Helen H Lu; Jodie Moreau; Ivan Martin; John C Richmond; David L Kaplan

    2002-01-01

    A silk-fiber matrix was studied as a suitable material for tissue engineering anterior cruciate ligaments (ACL). The matrix was successfully designed to match the complex and demanding mechanical requirements of a native human ACL, including adequate fatigue performance. This protein matrix supported the attachment, expansion and differentiation of adult human progenitor bone marrow stromal cells based on scanning electron microscopy,

  20. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

    Microsoft Academic Search

    Anthony M. Buoncristiani; Fotios P. Tjoumakaris; James S. Starman; Mario Ferretti; Freddie H. Fu

    2006-01-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed by orthopaedic surgeons. The procedure has improved significantly since its inception in 1900 and continues to be intensively studied with outcomes receiving considerable attention. Traditional ACL reconstruction techniques have focused on one portion of the ACL—the anteromedial bundle. Single-bundle ACL reconstruction is the criterion standard and has

  1. Criterion-based rehabilitation program after anterior cruciate ligament reconstruction

    Microsoft Academic Search

    Elizabeth A. Eckersley; Julie M. Fritz; James J. Irrgang

    1995-01-01

    Traditional rehabilitation protocols consist of a progression of exercises and functional activities based on timeframes that serve as strict guidelines for physical therapists and athletic trainers. Patients who have undergone reconstruction of the anterior cruciate ligament are guided through the process via written schedule which often overlooks their ability to master basic functional activities, such as walking. Basic science and

  2. Polypropylene braid augmented and nonaugmented intraarticular anterior cruciate ligament reconstruction

    Microsoft Academic Search

    James H. Roth; John C. Kennedy; Harry Lockstadt; Catherine L. Mccallum; Leonard A. Cunning

    1985-01-01

    The purpose of this clinical retrospective study is to determine whether a polypropylene braid (PB) used to augment an intraarticular autograft to reconstruct the anterior cruciate ligament (ACL) is safe and to deter mine whether the PB improves the efficacy of the procedure.A simultaneous review was performed of patients who had undergone an intraarticular ACL reconstruc tion using an autograft

  3. Prevention of anterior cruciate ligament injuries in soccer

    Microsoft Academic Search

    A. Caraffa; G. Cerulli; M. Projetti; G. Aisa; A. Rizzo

    1996-01-01

    Proprioceptive training has been shown to reduce the incidence of ankle sprains in different sports. It can also improve rehabilitation after anterior cruciate ligament (ACL) injuries whether treated operatively or nonoperatively. Since ACL injuries lead to long absence from sports and are one of the main causes of permanent sports disability, it is essential to try to prevent them. In

  4. The biomechanics of anterior cruciate ligament rehabilitation and reconstruction

    Microsoft Academic Search

    Steven W. Arms; Malcolm H. Pope; Robert J. Johnson; Richard A. Fischer; Inga Arvidsson; Ejnar Eriksson

    1984-01-01

    The rehabilitation of knee injuries involving the anterior cruciate ligament (ACL) is controversial. This paper describes strain in the normal and reconstructed ACL during a series of passive and active tests of knee flexion with and without varus, valgus, and axial rotation torques on the tibia. Strain in the human knee ACL was significantly different depending on whether the knee

  5. Knee rehabilitation after anterior cruciate ligament reconstruction and repair

    Microsoft Academic Search

    Lonnie Paulos; Frank R. Noyes; Edward Grood; David L. Butler

    1981-01-01

    The purpose of this paper is to present the specifics and rationale of our postoperative rehabilitation pro gram after anterior cruciate ligament (ACL) recon struction and compare it with an international survey of 50 knee experts. It is important to stress that what we present is opinion. This opinion, however, is based on principles, guidelines, and specifics which we be

  6. Posterior cruciate ligament reconstruction using an arthroscopic femoral inlay technique.

    PubMed

    Margheritini, Fabrizio; Frascari Diotallevi, Francesco; Mariani, Pier Paolo

    2011-12-01

    Several techniques for posterior cruciate ligament reconstruction have been developed. The purpose of this paper is to present a new surgical technique that provides greater anatomical femoral fixation avoiding the sharp angle made by the graft at the exit of the femoral tunnel. PMID:21409466

  7. Septic arthritis following anterior cruciate ligament reconstruction: a comprehensive review of the literature.

    PubMed

    Scully, William F; Fisher, Susan G; Parada, Stephen A; Arrington, Edward D; Arrington, Edward A

    2013-01-01

    Septic arthritis following anterior cruciate ligament (ACL) reconstruction is an uncommon but potentially serious complication. The incidence of infection is approximately 0.44%. Staphylococcus and streptococcus strains are the most common infectious pathogens. Infection is typically via direct inoculation. Articular cartilage damage is primarily the result of the unregulated host inflammatory response. The timing of presentation is typically <2 months following surgery. Presenting symptoms commonly mirror normal postoperative findings, making diagnosis difficult. Although laboratory inflammatory markers are often elevated, knee arthrocentesis is the gold standard for diagnosis. Treatment involves serial arthroscopic or open irrigation and debridement procedures and antibiotic management. Graft retention is often possible, although fixation implants may require removal or exchange. Successful results have been reported following infection eradication in both graft retention and early revision ACL reconstruction scenarios. PMID:23628565

  8. Simultaneous rupture of the patellar tendon and the anterior cruciate ligament: report of three cases.

    PubMed

    Mariani, Pier Paolo; Cerullo, Guglielmo; Iannella, Germano

    2013-12-01

    This study describes three cases of simultaneous ruptures of the patellar tendon (PT) and the anterior cruciate ligament (ACL). The treatment and the pathogenesis of this rare lesion are discussed. All three cases demonstrated lesions of all structures at the medial compartment. Unlike other reported cases, where an eccentric contraction of the quadriceps was present, the patients of the present study had sustained a forceful valgus injury with external rotation. We detected no displacements of the patella in any patients. All cases underwent a staged surgical procedure. Repair of the PT and of medial peripheral structures was performed immediately after injury; then, once the patients regained a full range of motion (ROM), they underwent an arthroscopic reconstruction of the ACL with ipsilateral hamstrings. At the follow-up stage, all cases showed a stable knee without restricted ROM. PMID:23288778

  9. The figure-of-nine leg position for anatomic anterior cruciate ligament reconstruction.

    PubMed

    Furumatsu, T; Fujii, M; Tanaka, T; Miyazawa, S; Ozaki, T

    2015-05-01

    Anatomic double-bundle anterior cruciate ligament (ACL) reconstruction can restore the function and kinematics of the knee in ACL-deficient patients. Several outside-in drilling systems for accurate femoral tunnel creations have been developed. However, the femoral tunnel creation at the lower position of the intercondylar notch can be difficult in a usual leg position with the knee flexed at 90° without varus stress. This technical note describes that the figure-of-nine leg position provides a better arthroscopic view to safely clean up the ACL femoral footprint located at the lower area of the lateral intercondylar wall. This position is useful to create the optimal femoral tunnels using the outside-in drilling technique, without damaging the lateral meniscus posterior root, lateral tibial eminence, and supplemental fibers that bridge the gap between the lateral meniscus and the ACL tibial insertion. PMID:25748135

  10. Arthroscopic Treatment of Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament Using the TightRope Fixation Device

    PubMed Central

    Gwinner, Clemens; Kopf, Sebastian; Hoburg, Arnd; Haas, Norbert P.; Jung, Tobias M.

    2014-01-01

    Avulsion fracture of the posterior cruciate ligament from its tibial insertion is a rare condition. Early surgical treatment has been regarded as necessary, but the optimal surgical technique remains unclear. The purpose of this technical note is to present a novel all-inside arthroscopic reconstruction technique for bony tibial avulsion fractures of the posterior cruciate ligament using the TightRope device (Arthrex, Naples, FL). PMID:25126507

  11. Updates in biological therapies for knee injuries: anterior cruciate ligament.

    PubMed

    da Silveira Franciozi, Carlos Eduardo; Ingham, Sheila Jean McNeill; Gracitelli, Guilherme Conforto; Luzo, Marcus Vinicius Malheiros; Fu, Freddie H; Abdalla, Rene Jorge

    2014-09-01

    There have been many advances in anterior cruciate ligament reconstruction (ACLR) techniques incorporating biological treatment. The aim of this review is to discuss the recent contributions that may enlighten our understanding of biological therapies for anterior cruciate ligament (ACL) injuries and improve management decisions involving these enhancement options. Three main biological procedures will be analyzed: bio-enhanced ACL repair, bio-enhanced ACLR scrutinized under the four basic principles of tissue engineering (scaffolds, cell sources, growth factors/cytokines including platelet-rich plasma, and mechanical stimuli), and remnant-preserving ACLR. There is controversial information regarding remnant-preserving ACLR, since different procedures are grouped under the same designation. A new definition for remnant-preserving ACLR surgery is proposed, dividing it into its three major procedures (selective bundle augmentation, augmentation, and nonfunctional remnant preservation); also, an ACL lesion pattern classification and a treatment algorithm, which will hopefully standardize these terms and procedures for future studies, are presented. PMID:25070265

  12. Tissue Engineering Strategies for Regeneration of the Anterior Cruciate Ligament

    Microsoft Academic Search

    Michael G. Dunn

    The anterior cruciate ligament (ACL) is a primary stabilizer of the knee joint that is frequently injured, compromising knee\\u000a stability and leading to degeneration of other joint structures. Because the ACL has a poor intrinsic healing capacity, surgical\\u000a reconstruction is required to restore knee function in young active patients. Biological grafts are the gold standard for\\u000a ACL reconstruction, resulting in

  13. Anterior cruciate ligament reconstruction complicated by pyoderma gangrenosum.

    PubMed

    Bagouri, E; Smith, Jon; Geutjens, G

    2012-11-01

    We report a case of pyoderma gangrenosum as a complication of an anterior cruciate ligament reconstruction in a patient with inflammatory bowel disease, which was misdiagnosed initially as a post-operative wound infection. An early dermatology opinion and skin biopsy should be considered in cases of suspected infection where thorough surgical debridement and antimicrobial therapy has failed to improve the clinical picture. PMID:23131219

  14. Anatomic anterior cruciate ligament reconstruction with quadriceps tendon autograft.

    PubMed

    Rabuck, Stephen J; Musahl, Volker; Fu, Freddie H; West, Robin V

    2013-01-01

    A multitude of graft options exist including both allograft and autograft sources for reconstruction of the anterior cruciate ligament. With recent concerns regarding the early graft failure and cost-effectiveness of allograft sources, more attention has been directed toward autograft options. However, autograft harvest has been associated with specific morbidity that can result in suboptimal outcomes. The quadriceps tendon is an excellent biomechanical and biologic option. PMID:23177469

  15. Kinematic study following double-bundle, anterior cruciate ligament reconstruction

    Microsoft Academic Search

    Jong Keun Seon; Eun Kyoo Song; Bong Hyun Bae; Sang Jin Park; Taek Rim Yoon; Sang Gwon Cho; Jae Joon Lee; Myung Sun Kim

    2007-01-01

    The purpose of this study was to evaluate tibiofemoral kinematics after double-bundle anterior cruciate ligament (ACL) reconstructions\\u000a and compare them with those of successful single-bundle reconstructions and contralateral normal knees using open MR images.\\u000a We obtained MR images based on the flexion angle without weight-bearing, from 20 patients with successful unilateral single-bundle\\u000a (10 patients) and double-bundle (10 patients) ACL reconstructions

  16. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

    Microsoft Academic Search

    Kazunori Yasuda; Yoshie Tanabe; Eiji Kondo; Nobuto Kitamura; Harukazu Tohyama

    2010-01-01

    Several double-bundle anterior cruciate ligament (ACL) reconstruction procedures were reported in the 1980s and 1990s. However, no significant differences were found in the clinical results between these double-bundle procedures and single-bundle procedures because the double-bundle procedures appeared to reconstruct only the anteromedial bundle with 2 bundles. In the early 2000s, we proposed a new concept of anatomic reconstruction of the

  17. Pattern of anterior cruciate ligament force in normal walking

    Microsoft Academic Search

    Kevin B. Shelburne; Marcus G. Pandy; Frank C. Anderson; Michael R. Torry

    2004-01-01

    The goal of this study was to calculate and explain the pattern of anterior cruciate ligament (ACL) loading during normal level walking. Knee-ligament forces were obtained by a two-step procedure. First, a three-dimensional (3D) model of the whole body was used together with dynamic optimization theory to calculate body-segmental motions, ground reaction forces, and leg-muscle forces for one cycle of

  18. Anterior cruciate ligament functional brace use in sports.

    PubMed

    Wojtys, E M; Kothari, S U; Huston, L J

    1996-01-01

    The routine use of functional knee braces in the anterior cruciate ligament-deficient, injured, or reconstructed knee, lacks biomechanical support. Although subjective reports favoring bracing are plentiful, objective proof of significant control of tibial translation is not. This in vivo study was designed to assess the effect of six popular braces on anterior tibial translation, isokinetic performance, and neuromuscular function in five chronically unstable anterior cruciate ligament-deficient knees. A knee stress test was performed on a specially designed device that allowed free tibial movement while monitoring anterior tibial translation and muscle function in the quadriceps, hamstring, and gastrocnemius muscles. Results show that braces can decrease anterior tibial translation between 28.8% and 39.1% without the stabilizing contractions of the hamstring, quadriceps, and gastrocnemius muscles. With lower extremity muscle activation and bracing, anterior tibial translation was decreased between 69.8% and 84.9%. Some improvement in spinal level muscle reaction times was seen with brace use, especially in the quadriceps muscle. Unfortunately, most braces appear to consistently slow hamstring muscle reaction times at the voluntary level. PMID:8827316

  19. Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using a Three-Dimensional Fluoroscopic Navigation System

    PubMed Central

    Inui, Hiroshi; Sanada, Takaki; Nakamura, Kensuke; Yamagami, Ryota; Masuda, Hironari; Tanaka, Sakae; Nakagawa, Takumi

    2014-01-01

    Introduction Recently, remnant-preserving anterior cruciate ligament (ACL) reconstruction has been increasingly performed to achieve revascularization, cell proliferation, and recovery of high-quality proprioception. However, poor arthroscopic visualization makes accurate socket placement during remnant-preserving ACL reconstruction difficult. This study describes a surgical technique used to create an anatomical femoral socket with a three-dimensional (3D) fluoroscopy based navigation system during technically demanding remnant-preserving ACL reconstruction. Surgical Technique After a reference frame was attached to the femur, an intraoperative image of the distal femur was obtained, transferred to the navigation system and reconstructed into a 3D image. A navigation computer helped the surgeon visualize the entire lateral wall of the femoral notch and lateral intercondylar ridge, even when the remnant of the ruptured ACL impeded arthroscopic visualization of the bone surface. When a guide was placed, the virtual femoral tunnel overlapped the reconstructed 3D image in real time; therefore, only minimal soft tissue debridement was required. Materials and Methods We treated 47 patients with remnant-preserving ACL reconstruction using this system. The center of the femoral socket aperture was calculated according to the quadrant technique using 3D computed tomography imaging. Results The femoral socket locations were considered to be an anatomical footprint in accordance with previous cadaveric studies. Conclusions The 3D fluoroscopy-based navigation can assist surgeons in creating anatomical femoral sockets during remnant-preserving ACL reconstruction. PMID:25229047

  20. Clinical Presentation of Staphylococcus epidermidis Septic Arthritis Following Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kim, Young Mo

    2012-01-01

    Purpose This study evaluated the clinical presentations of Staphylococcus epidermidis (S. epidermidis) septic arthritis after arthroscopic anterior cruciate ligament reconstruction (ACLR). Materials and Methods Between September 2006 and February 2008, S. epidermidis septic arthritis developed in six patients following arthroscopic ACLR. We reviewed the medical records retrospectively and interviewed the patients. Results The average interval between ACLR and symptom onset was 4.7 days (range, 2 to 8 days). Local warmth, swelling limited knee motion and general malaise were observed in varying degrees in all the patients. The fever was generally slight with an intermittent spiking pattern. Postoperative erythrocyte sedimentation rate and C-reactive protein were elevated. After the development of infection, the joint was aspirated in all cases. The white blood cell count was at least 22,400, with the presence of 80 to 90% of polymorphonuclear cells. All the patients had a few Gram-positive cocci and positive cultures for S. epidermidis. Conclusions The symptoms, signs and laboratory findings of S. epidermidis septic arthritis following ACLR are nonspecific with various clinical presentations. So the diagnosis is often delayed. Positive gram staining can be used to confirm septic arthritis. Careful observation for septic arthritis is advised in case of presence of any abnormality after ACLR. PMID:22570852

  1. Arthroscopic Augmentation With Subscapularis Tendon in Anterior Shoulder Instability With Capsulolabral Deficiency

    PubMed Central

    Maiotti, Marco; Massoni, Carlo

    2013-01-01

    The treatment of chronic shoulder instability with poor quality of the anterior capsulolabral tissue is still controversial. In these cases the Latarjet procedure is certainly more effective in preventing recurrence than an arthroscopic capsular repair. However, several studies have reported a variety of severe complications related to the Latarjet procedure because of the use of bone augmentation and hardware implantation; moreover, the arthroscopic version of the Latarjet procedure is technically difficult and potentially dangerous because of the proximity of neurovascular structures. The aim of this report is to describe an innovative arthroscopic technique consisting of an augmentation of the anterior capsulolabral tissue using the articular portion of the subscapularis tendon and knotless suture anchors paired with high-strength tape for its fixation to the anterior glenoid edge. In the absence of severe bone deficiency of the anterior glenoid edge, this procedure can minimize arthroscopic technique failures, restoring the anterior capsulolabral wall without any significant reduction of shoulder functionality. PMID:24266004

  2. Outcome of transtibial AperFix system in anterior cruciate ligament injuries

    PubMed Central

    Görmeli, Gökay; Görmeli, C Ay?e; Karakaplan, Mustafa; Korkmaz, M Fatih; Diliç?k?k, U?ur; Gözükara, Harika

    2015-01-01

    Background: The anterior cruciate ligament (ACL) is one of the major stabilizing factor of the knee that resist anterior translation, valgus and varus forces. ACL is the most commonly ruptured ligament of the knee. The graft fixation to bone is considered to be the weakest link of the reconstruction. According to the parallel forces to the tibial drill hole and the quality of tibial metaphyseal bone is inferior to femoral bone stock, graft fixation to the tibia is more difficult to secure. AperFix system (Cayenne Medical, Inc., Scottsdale, Arizona, USA) which consists femoral and tibial component that includes bioinert polymer polyetheretherketone (PEEK) is one of the new choice for ACL reconstruction surgery. aim of this study was to assess the clinical outcomes and fixation durability of the AperFix (Cayenne Madical, Inc., Scottsdale, Arizona, USA) system and to determine the effect of patient's age in arthroscopic reconstruction of the anterior cruciate ligament. Materials and Methods: Patients with symptomatic anterior cruciate ligament rupture underwent arthroscopic reconstruction. Patients were evaluated in terms of range of motion (ROM) values; Lysholm, Cincinati and Tegner activity scales; laxity testing and complications. Femoral tunnel widening was assessed by computer tomography scans. Early postoperative and last followup radiographs were compared. Results: Fifty one patients were evaluated with mean followup of 29 months (range 25–34 months). Mean age at the surgery was 26.5 ± 7.2 years. Lysholm, Cincinati and Tegner activity scales were significantly higher from preoperative scores (Lysholm scores: Preoperative: 51.4 ± 17.2, postoperative: 88.6 ± 7.7 [P < 0.001]; Tegner activity scores: Preoperative 3.3 ± 1.38, postoperative: 5.3 ± 1.6 [P < 0.001]; Cincinati scores: Preoperative: 44.3 ± 17, postoperative: 81.3 ± 13.9 [P < 0.001]). The mean femoral tunnel diameter increased significantly from 9.94 ± 0.79 mm postoperatively to 10.79 ± 0.95 mm (P < 0.05). The mean ROM deficit (involved vs. contra knee) was ?7.2 ± 16 (P < 0.001). There was no significant difference for knee score, ROM deficits (<30 years: ?7.3 ± 15 and >30 years ?7.06 ± 19) and femoral tunnel enlargement (<30 years: 0.83 ± 0.52 and >30 years 0.87 ± 0.43) of the patients with below and above 30 year. There was no significant difference for knee scores and femoral tunnel enlargement between patients with meniscal injuries and don’t have meniscus lesions. Conclusion: The AperFix system gives satisfactory clinical and radiological results with low complication rate. However, long term clinical and radiological results are needed to decide the ideal anterior cruciate ligament reconstruction method. PMID:26015602

  3. Accelerated rehabilitation after anterior cruciate ligament reconstruction

    Microsoft Academic Search

    K. Donald Shelbourne; Paul Nitz

    1990-01-01

    To overcome many of the complications after ACL reconstruction (prolonged knee stiffness, limitation of complete extension, delay in strength recovery, anterior knee pain), yet still maintain knee stability, we devel oped a rehabilitation protocol that emphasizes full knee extension on the first postoperative day and immediate weightbearing according to the patient's tolerance. Of 800 patients who underwent intraarticular ACL patellar

  4. Thrombotic popliteal block following simultaneous bi-cruciate single-stage arthroscopic reconstruction in a neglected multiligamentous knee injury in a smoker.

    PubMed

    Panigrahi, Ranajit; Mahapatra, Amita Kumari; Palo, Nishit; Priyadarshi, Ashok

    2015-01-01

    We report a case of neglected multiligamentous injury that developed a complete thrombotic popliteal artery block following arthroscopic surgery. A 56-year-old man, a farmer, presented with an 8-month history of instability of the right knee. Examination revealed ipsilateral anterior (ACL)/posterior cruciate ligament (PCL) injuries. MRI and diagnostic arthroscopy confirmed complete ACL/PCL tear. Single-stage arthroscopic ACL/PCL reconstruction was performed. Postsurgery, the operated limb appeared swollen, firm and cold, without sensation or toe movement. Angiogram revealed complete thrombotic block of left popliteal artery. Fogarty's catheterism was performed and distal vascularity re-established. At 28?months, the patient was back at work with good functional outcome. We failed to examine the patient preoperatively in spite of his advanced age, history of beedi smoking and tobacco use, and presence of feeble vascular pulsations with thickened skin over leg and foot. Thus, in multiligamentous injuries, patient selection and thorough detailed clinical examination are the keys to successful arthroscopic procedures. PMID:26150635

  5. [Septic knee arthritis caused by Pseudomonas aeruginosa after anterior cruciate ligament reconstruction in an adolescent athlete].

    PubMed

    De la Garza-Castro, S; González-Rivera, C E; Vilchez-Cavazos, J F; Rositas-Noriega, F H; Mendoza-Lemus, O F

    2012-01-01

    Anterior cruciate ligament reconstruction is a very frequent procedure. Postoperative infection after this procedure is a catastrophic, although infrequent, complication. According to the literature, it occurs in less than 1% of all reconstructions done in the United States. We present herein a case report of septic arthritis of the posterior knee associated with anterior cruciate ligament reconstruction. PMID:23320342

  6. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING PATELLAR TENDON AND QUADRICEPS TENDON: A COMPARATIVE STUDY

    Microsoft Academic Search

    Nasser Sarrafan; Seyed Abdolhossein Mehdinasab

    Objective: The goal of this study was to compare the results of knee anterior cruciate ligament reconstruction with the use of patellar tendon and quadriceps tendon. Methodology: In this study 30 patients with rupture of anterior cruciate ligament of knee were compared in two 15-person group with the use of patellar tendon and quadriceps tendon. After precise rehabilitation program for

  7. Double-Bundle Anterior Cruciate Ligament ReconstructionA Computer-Assisted Orthopaedic Surgery Study

    Microsoft Academic Search

    Andrea Ferretti; Edoardo Monaco; Luca Labianca; Fabio Conteduca; Angelo De Carli

    2008-01-01

    Background: The biomechanical function of single-bundle anterior cruciate ligament reconstruction, in cadaveric studies, is successful in limiting anterior tibial translation in response to an anterior tibial load but seems to be insufficient to control a combined rotator load of internal and valgus torque. Anatomical double-bundle anterior cruciate ligament reconstruction might produce a better biomechanical outcome.Hypothesis: The addition of the posterolateral

  8. Does concomitant meniscectomy affect medium-term outcome of anterior cruciate ligament reconstruction? A preliminary report

    PubMed Central

    K?ska, Rafa?; Wito?ski, Dariusz

    2014-01-01

    Introduction Anterior cruciate ligament (ACL) injury is often accompanied by injuries of the menisci. In order to restore knee stability, anterior cruciate ligament reconstruction (ACLR) is performed, with meniscus surgery when needed. The purpose of this study was to assess the medium-term outcome of ACLR in subjects with and without concomitant meniscus tear and partial meniscectomy. Material and methods We prospectively studied 73 patients after arthroscopically assisted bone-patellar tendon-bone ACLR. Subjects were divided into two subgroups: those who had only ACLR (group A, 54 subjects with mean age 28, (SD 9)) and those who underwent both ACLR and concomitant partial meniscectomy (group B, 19 subjects, mean age 32 [11]). Subjects completed a disease-specific questionnaire, the Knee injury and Osteoarthritis Outcome Score (KOOS), preoperatively and at a minimum follow-up of 1 year. Results No differences in mean scores between group A and B were observed either preoperatively or at follow-up. We found a significant change in mean score in the KOOS subscale QoL in group A following ACLR (? = 9 points, p = 0.039). Most subjects improved in the KOOS subscales Sports and Recreation and QoL in both group A (59 and 52% respectively) and B (63 and 47% respectively). Eight subjects (15%) from group A and 1 (5%) from group B fulfilled criteria of functional recovery. Criteria of treatment failure were fulfilled in 17 subjects (32%) from A and 4 (21%) from group B. Conclusions Patients undergoing ACLR with partial meniscectomy had a similar medium-term outcome compared to individuals with ACL tear alone. PMID:25395952

  9. Ossicle in Anterior Cruciate Ligament: A Rare Occurrence

    PubMed Central

    Singh, Amanpreet; Gogna, Paritosh

    2014-01-01

    The occurrence of an intra-articular ossicle is not rare in the knee, with reports suggesting the existence of meniscal osscile. There are also reports describing the attachment of the posterolateral bundle of the anterior cruciate ligament (ACL) to an accessory ossicle. However, despite an extensive search of the English literature we did not find much written about an intrasubstance ossicle in the ACL. We present the case of a 13-year-old male with an intrasubstance ossicle in the anteromedial bundle of the ACL of his right knee. PMID:24822144

  10. Combined anterior cruciate ligament and medial collateral ligament injuries in adolescents.

    PubMed

    Sankar, Wudbhav N; Wells, Lawrence; Sennett, Brian J; Wiesel, Brent B; Ganley, Theodore J

    2006-01-01

    Although literature supports bracing of most medial collateral ligament (MCL) injuries followed by arthroscopic repair of anterior cruciate ligament (ACL) tears in adults with combined ACL-MCL injuries, little is published regarding the treatment of these injuries in the pediatric population. The purpose of this study was to present our outcomes after treatment of combined ACL-MCL injuries in a series of adolescents. All 180 patients who underwent ACL reconstruction at our children's hospital from January 1997 to January 2003 were reviewed to identify those patients with concomitant grade II or III MCL injuries. Clinical data were obtained from chart review. All patients were treated with a hinged brace for their MCL injury followed by delayed arthroscopic reconstruction of their ACL using a transphyseal technique with Achilles tendon soft tissue allograft. Patients were contacted by phone to complete Lysholm knee questionnaires and assess return to athletic competition. Data were compared with a control cohort of patients who underwent isolated ACL reconstruction using the same technique. Twelve (6.7%) of 180 patients had combined ACL-MCL injuries. There were 6 boys and 6 girls; the mean age was 15.6 years (range, 14-17 years). Follow-up averaged 5.3 years (range, 2.6-8.2 years), and no patients were lost to follow-up. At last examination, all patients had a stable knee on both Lachman and valgus stress tests; the mean Lysholm knee score was 96 (range, 94-100). All patients were able to return to their preinjury level of athletics. One patient required manipulation for arthrofibrosis. When compared with the control group of 19 isolated ACL reconstructions, there was no significant difference with regards to Lysholm scores or return to athletics. Bracing of grade 2 or 3 MCL injuries followed by ACL reconstruction was an effective means of treating combined ACL-MCL injuries in this small series of adolescent patients. PMID:17065935

  11. Superior labrum anterior to posterior lesions of the shoulder: Diagnosis and arthroscopic management

    PubMed Central

    Aydin, Nuri; Sirin, Evrim; Arya, Alp

    2014-01-01

    After the improvement in arthroscopic shoulder surgery, superior labrum anterior to posterior (SLAP) tears are increasingly recognized and treated in persons with excessive overhead activities like throwers. Several potential mechanisms for the pathophysiology of superior labral tears have been proposed. The diagnosis of this condition can be possible by history, physical examination and magnetic resonance imaging combination. The treatment of type 1 SLAP tears in many cases especially in older patients is non-operative but some cases need arthroscopic intervention. The arthroscopic management of type 2 lesions in older patients can be biceps tenodesis, but young and active patients like throwers will need an arthroscopic repair. The results of arthroscopic repair in older patients are not encouraging. The purpose of this study is to perform an overview of the diagnosis of the SLAP tears and to help decision making for the surgical management. PMID:25035838

  12. Kinematic Analysis of Five Different Anterior Cruciate Ligament Reconstruction Techniques.

    PubMed

    Gadikota, Hemanth R; Hosseini, Ali; Asnis, Peter; Li, Guoan

    2015-06-01

    Several anatomical anterior cruciate ligament (ACL) reconstruction techniques have been proposed to restore normal joint kinematics. However, the relative superiorities of these techniques with one another and traditional single-bundle reconstructions are unclear. Kinematic responses of five previously reported reconstruction techniques (single-bundle reconstruction using a bone-patellar tendon-bone graft [SBR-BPTB], single-bundle reconstruction using a hamstring tendon graft [SBR-HST], single-tunnel double-bundle reconstruction using a hamstring tendon graft [STDBR-HST], anatomical single-tunnel reconstruction using a hamstring tendon graft [ASTR-HST], and a double-tunnel double-bundle reconstruction using a hamstring tendon graft [DBR-HST]) were systematically analyzed. The knee kinematics were determined under anterior tibial load (134 N) and simulated quadriceps load (400 N) at 0°, 15°, 30°, 60°, and 90° of flexion using a robotic testing system. Anterior joint stability under anterior tibial load was qualified as normal for ASTR-HST and DBR-HST and nearly normal for SBR-BPTB, SBR-HST, and STDBR-HST as per the International Knee Documentation Committee knee examination form categorization. The analysis of this study also demonstrated that SBR-BPTB, STDBR-HST, ASTR-HST, and DBR-HST restored the anterior joint stability to normal condition while the SBR-HST resulted in a nearly normal anterior joint stability under the action of simulated quadriceps load. The medial-lateral translations were restored to normal level by all the reconstructions. The internal tibial rotations under the simulated muscle load were over-constrained by all the reconstruction techniques, and more so by the DBR-HST. All five ACL reconstruction techniques could provide either normal or nearly normal anterior joint stability; however, the techniques over-constrained internal tibial rotation under the simulated quadriceps load. PMID:26060604

  13. Kinematic Analysis of Five Different Anterior Cruciate Ligament Reconstruction Techniques

    PubMed Central

    Gadikota, Hemanth R; Hosseini, Ali; Asnis, Peter

    2015-01-01

    Several anatomical anterior cruciate ligament (ACL) reconstruction techniques have been proposed to restore normal joint kinematics. However, the relative superiorities of these techniques with one another and traditional single-bundle reconstructions are unclear. Kinematic responses of five previously reported reconstruction techniques (single-bundle reconstruction using a bone-patellar tendon-bone graft [SBR-BPTB], single-bundle reconstruction using a hamstring tendon graft [SBR-HST], single-tunnel double-bundle reconstruction using a hamstring tendon graft [STDBR-HST], anatomical single-tunnel reconstruction using a hamstring tendon graft [ASTR-HST], and a double-tunnel double-bundle reconstruction using a hamstring tendon graft [DBR-HST]) were systematically analyzed. The knee kinematics were determined under anterior tibial load (134 N) and simulated quadriceps load (400 N) at 0°, 15°, 30°, 60°, and 90° of flexion using a robotic testing system. Anterior joint stability under anterior tibial load was qualified as normal for ASTR-HST and DBR-HST and nearly normal for SBR-BPTB, SBR-HST, and STDBR-HST as per the International Knee Documentation Committee knee examination form categorization. The analysis of this study also demonstrated that SBR-BPTB, STDBR-HST, ASTR-HST, and DBR-HST restored the anterior joint stability to normal condition while the SBR-HST resulted in a nearly normal anterior joint stability under the action of simulated quadriceps load. The medial-lateral translations were restored to normal level by all the reconstructions. The internal tibial rotations under the simulated muscle load were over-constrained by all the reconstruction techniques, and more so by the DBR-HST. All five ACL reconstruction techniques could provide either normal or nearly normal anterior joint stability; however, the techniques over-constrained internal tibial rotation under the simulated quadriceps load. PMID:26060604

  14. How iliotibial tract injuries of the knee combine with acute anterior cruciate ligament tears to influence abnormal anterior tibial displacement

    Microsoft Academic Search

    Glenn C. Terry; Lyle A. Norwood; Jack C. Hughston; Kenneth M. Caldwell

    1993-01-01

    A knowledge of the patterns of injury to the compo nents of the iliotibial tract allows a clearer interpretation of motion limits testing in patients with abnormal ante rior tibial translation of the knee (anterior cruciate liga ment-deficient knees).Eighty-two consecutive patients with acute knee in juries were classified as anteromedial-anterolateral ro tatory instability (anterior cruciate ligament-deficient) based on the abnormal

  15. Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature

    PubMed Central

    Keyhani, Sohrab; Vaziri, Arash Sharafat; shafiei, Hossein; Mardani-Kivi, Mohsen

    2015-01-01

    A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture. A 35-year old male soccer player with a history of ACL tear from one year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages first fixation of the fracture and then ACL re-revision after fracture healing was complete. Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction. PMID:26110183

  16. Reconstruction of anterior cruciate ligaments with bone-patellar tendon-bone and achilles tendon allografts.

    PubMed

    Levitt, R L; Malinin, T; Posada, A; Michalow, A

    1994-06-01

    Two hundred fourteen patients had anterior cruciate ligament (ACL) reconstructions performed with banked freeze-dried or frozen allografts using an arthroscopic-assisted technique. Of these, 181 patients were available for follow-up testing and examination. Minimum follow-up time was four years (average, 57 months). All patients were evaluated by using KT-1000 arthrometer and Biodex testing as well as by physical examination. Final results were rated as satisfactory or unsatisfactory by using a modified Feagin knee scoring scale. Patients who were classified as good or excellent were considered to have satisfactory results. Those who were classified as fair or poor were considered to have unsatisfactory results. During the course of the study, 79% of the patients had satisfactory results. The percentage of patients with satisfactory results increased as the study progressed. The surgical technique was modified as new biomechanical principles were applied to ACL reconstruction. Rehabilitation of the patients was also progressively changed from conservative to aggressive. The authors attribute the improvement from 67% of patients with satisfactory results in 1984 to 85% in 1988 at least partially to these modifications. It was concluded that either frozen or freeze-dried aseptically excised and processed bone-patellar tendon-bone and Achilles tendon allografts can serve adequately for the reconstruction of ACLs. Complications may be reduced and clinical end results improved by adherence to an exact, reproducible surgical technique and an aggressive rehabilitation regimen. PMID:8194256

  17. TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Yasen, Sam K.; Logan, James S.; Smith, James O.; Nancoo, Tamara; Risebury, Mike J.; Wilson, Adrian J.

    2013-01-01

    Cadaveric and clinical biomechanical studies show improved kinematic restoration using double-bundle anterior cruciate ligament (ACL) reconstruction techniques. These have been criticized in the past for being technically challenging. We present a novel 3-socket approach for anatomic “all-inside” double-bundle reconstruction using a single hamstring tendon fashioned to create a trifurcate graft: the TriLink technique. The semitendinosus alone is harvested, quadrupled, and attached to 3 suspensory fixation devices in a Y-shaped configuration, creating a 4-stranded tibial limb and 2 double-stranded femoral limbs. A medial viewing/lateral working arthroscopic approach is adopted using specifically designed instrumentation. Anatomic placement of the 2 femoral tunnels is performed by a validated direct measurement technique. A single mid-bundle position is used on the tibia. Both femoral and tibial sockets are created in a retrograde manner using outside-to-in drilling. This is a simplified operative technique for anatomic double-bundle ACL reconstruction that maximizes bone preservation. The TriLink construct replicates the 2 bundles of the ACL, conferring native functional anisometry and improving femoral footprint coverage while avoiding the complexities and pitfalls of double–tibial tunnel techniques. Preservation of the gracilis reduces the morbidity of hamstring harvest and allows greater flexibility in graft choice in cases requiring multiligament reconstruction. PMID:24749016

  18. Outcome of double bundle anterior cruciate ligament reconstruction using crosspin and aperture fixation

    PubMed Central

    Joshi, Deepak; Jain, Vineet; Goyal, Ankit; Bahl, Vibhu; Modi, Prashant; Chaudhary, Deepak

    2014-01-01

    Background: Double bundle anterior cruciate ligament (DBACL) reconstruction is said to reproduce the native anterior cruciate ligament (ACL) anatomy better than single bundle anterior cruciate ligament, whether it leads to better functional results is debatable. Different fixation methods have been used for DBACL reconstruction, the most common being aperture fixation on tibial side and cortical suspensory fixation on the femoral side. We present the results of DBACL reconstruction technique, wherein on the femoral side anteromedial (AM) bundle is fixed with a crosspin and aperture fixation was done for the posterolateral (PL) bundle. Materials and Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Results: The KT-1000 results were evaluated using paired t test with the P value set at 0.001. At the end of 1 year, the anteroposterior side to side translation difference (KT-1000 manual maximum) showed mean improvement from 5.1 mm ± 1.5 preoperatively to 1.6 mm ± 1.2 (P < 0.001) postoperatively. The Lysholm score too showed statistically significant (P < 0.001) improvement from 52.4 ± 15.2 (range: 32-76) preoperatively to a postoperative score of 89.1 ± 3.2 (range 67-100). According to the IKDC score 90% patients had normal results (Category A and B). The AM femoral tunnel initial posterior blow out was seen in 4 patients and confluence in the intraarticular part of the femoral tunnels was seen in 6 patients intraoperatively. The quadriceps strength on isokinetic testing had an average deficit of 10.3% while the hamstrings had a 5.2% deficit at the end of 1 year as compared with the normal side. Conclusion: Our study revealed that the DBACL reconstruction using crosspin fixation for AM bundle and aperture fixation for PL bundle on the femoral side resulted in significant improvement in KT 1000, Lysholm and IKDC scores. PMID:24600062

  19. A Comparison of Anterior and Posterior Cruciate Ligament Laxity Between Female and Male Basketball Players.

    ERIC Educational Resources Information Center

    Weesner, Carol L.; And Others

    1986-01-01

    The anterior cruciate ligament and posterior cruciate ligament laxity of 90 uninjured male and female high school players were measured. No significant differences were found, indicating that the greater female injury rate may be due to inadequate conditioning, not greater knee ligament laxity. (Author/MT)

  20. Diagnostic Value of Knee Arthrometry in the Prediction of Anterior Cruciate Ligament Strain During Landing

    PubMed Central

    Kiapour, Ata M.; Wordeman, Samuel C.; Paterno, Mark V.; Quatman, Carmen E.; Levine, Jason W.; Goel, Vijay K.; Demetropoulos, Constantine K.; Hewett, Timothy E.

    2014-01-01

    Background Previous studies have indicated that higher knee joint laxity may be indicative of an increased risk of anterior cruciate ligament (ACL) injuries. Despite the frequent clinical use of knee arthrometry in the evaluation of knee laxity, little data exist to correlate instrumented laxity measures and ACL strain during dynamic high-risk activities. Purpose/Hypotheses The purpose of this study was to evaluate the relationships between ACL strain and anterior knee laxity measurements using arthrometry during both a drawer test and simulated bipedal landing (as an identified high-risk injurious task). We hypothesized that a high correlation exists between dynamic ACL strain and passive arthrometry displacement. The secondary hypothesis was that anterior knee laxity quantified by knee arthrometry is a valid predictor of injury risk such that specimens with greater anterior knee laxity would demonstrate increased levels of peak ACL strain during landing. Study Design Controlled laboratory study. Methods Twenty cadaveric lower limbs (mean age, 46 ± 6 years; 10 female and 10 male) were tested using a CompuKT knee arthrometer to measure knee joint laxity. Each specimen was tested under 4 continuous cycles of anterior-posterior shear force (±134 N) applied to the tibial tubercle. To quantify ACL strain, a differential variable reluctance transducer (DVRT) was arthroscopically placed on the ACL (anteromedial bundle), and specimens were retested. Subsequently, bipedal landing from 30 cm was simulated in a subset of 14 specimens (mean age, 45 ± 6 years; 6 female and 8 male) using a novel custom-designed drop stand. Changes in joint laxity and ACL strain under applied anterior shear force were statistically analyzed using paired sample t tests and analysis of variance. Multiple linear regression analyses were conducted to determine the relationship between anterior shear force, anterior tibial translation, and ACL strain. Results During simulated drawer tests, 134 N of applied anterior shear load produced a mean peak anterior tibial translation of 3.1 ± 1.1 mm and a mean peak ACL strain of 4.9% ± 4.3%. Anterior shear load was a significant determinant of anterior tibial translation (P <.0005) and peak ACL strain (P = .04). A significant correlation (r = 0.52, P <.0005) was observed between anterior tibial translation and ACL strain. Cadaveric simulations of landing produced a mean axial impact load of 4070 ± 732 N. Simulated landing significantly increased the mean peak anterior tibial translation to 10.4 ± 3.5 mm and the mean peak ACL strain to 6.8% ± 2.8% (P <.0005) compared with the prelanding condition. Significant correlations were observed between peak ACL strain during simulated landing and anterior tibial translation quantified by knee arthrometry. Conclusion Our first hypothesis is supported by a significant correlation between arthrometry displacement collected during laxity tests and concurrent ACL strain calculated from DVRT measurements. Experimental findings also support our second hypothesis that instrumented measures of anterior knee laxity predict peak ACL strain during landing, while specimens with greater knee laxity demonstrated higher levels of peak ACL strain during landing. Clinical Relevance The current findings highlight the importance of instrumented anterior knee laxity assessments as a potential indicator of the risk of ACL injuries in addition to its clinical utility in the evaluation of ACL integrity. PMID:24275863

  1. Biomimetic tissue-engineered anterior cruciate ligament replacement

    PubMed Central

    Cooper, James A.; Sahota, Janmeet S.; Gorum, W. Jay; Carter, Janell; Doty, Stephen B.; Laurencin, Cato T.

    2007-01-01

    There are >200,000 anterior cruciate ligament (ACL) ruptures each year in the United States, and, due to the poor healing properties of the ACL, surgical reconstruction with autograft or allograft tissue is the current treatment of these injuries. To regenerate the ACL, the ideal matrix should be biodegradable, porous, and exhibit sufficient mechanical strength to allow formation of neoligament tissue. Researchers have developed ACL scaffolds with collagen fibers, silk, biodegradable polymers, and composites with limited success. Our group has developed a biomimetic ligament replacement by using 3D braiding technology. In this preliminary in vivo rabbit model study for ACL reconstruction, the histological and mechanical evaluation demonstrated excellent healing and regeneration with our cell-seeded, tissue-engineered ligament replacement. PMID:17360607

  2. Estimation of in-vivo forces within Anterior Cruciate Ligament in response to increased weightbearing

    E-print Network

    Hosseini, Ali, M. Eng. Massachusetts Institute of Technology

    2010-01-01

    The knowledge of Anterior Cruciate Ligament (ACL) forces in-vivo is instrumental for understanding ACL injury mechanisms and for improvement of surgical ACL reconstruction. The goal of this thesis was to develop and implement ...

  3. In-vivo Anterior Cruciate Ligament Elongation in Response to Axial Tibial Loads

    E-print Network

    Gill, Thomas J.

    Background: The knowledge of in vivo anterior cruciate ligament (ACL) deformation is fundamental for understanding ACL injury mechanisms and for improving surgical reconstruction of the injured ACL. This study investigated ...

  4. Effects of different double-bundle anterior cruciate ligament reconstructions on femur stress

    Microsoft Academic Search

    Hong-Guang Zheng; Rong-Ying Huang; Qiang Xu; Hai-Dong Zheng

    2011-01-01

    No quantitative data were reported in the literature regarding the effects of different techniques in double-bundle ACL reconstruction on femur stress. In this study models of the intact , double-femoral double-tibial tunnel the anterior cruciate ligament reconstruction (DF-DT), single-femoral double-tibial tunnel the anterior cruciate ligament reconstruction (SF-DT) were built at flexion angles of 0°, 25°, 60° and 80° based on

  5. Double-Bundle Anterior Cruciate Ligament ReconstructionA Comprehensive Kinematic Study Using Navigation

    Microsoft Academic Search

    Andrea Ferretti; Edoardo Monaco; Luca Labianca; Angelo De Carli; Barbara Maestri; Fabio Conteduca

    2009-01-01

    Background: Single-bundle anterior cruciate ligament reconstruction seems to be insufficient to control a combined rotatory load of internal and valgus torque, whereas anatomical double-bundle reconstruction might produce a better biomechanical outcome, especially during rotatory loads.Hypothesis: The addition of the posterolateral bundle to the anteromedial bundle, in an in vivo double-bundle computer-assisted anterior cruciate ligament reconstruction, is able to reduce the

  6. Anatomic Double Bundle: A New Concept in Anterior Cruciate Ligament Reconstruction Using the Quadriceps Tendon

    Microsoft Academic Search

    Bertrand Sonnery-Cottet; Pierre Chambat

    2006-01-01

    Surgical procedures for double-bundle anterior cruciate ligament reconstruction, which currently use hamstring graft, have been described, but some concerns remain regarding graft fixation and the ability to obtain adequate bundle size. We report an original double-bundle anterior cruciate ligament reconstruction technique using a quadriceps tendon graft and a simplified outside-in femoral tunnel–drilling process. The graft consists of a patellar bone

  7. Radiofrequency treatment weakens the fatigue characteristics of rabbit anterior cruciate ligament

    Microsoft Academic Search

    A Merter Ozenci; Manohar M Panjabi

    2003-01-01

    Objective. To evaluate the radiofrequency treatment applied to an intact anterior cruciate ligament, and to quantify the mechanical effects of controlled cyclic loading (simulating activities of daily living) post-treatment.Design. An in vitro radiofrequency energy application to the rabbit anterior cruciate ligament and cyclic loading of the treated ligament.Background. Effect of cyclic loading on the radiofrequency treated ligament in a controlled

  8. Isokinetic and anterior cruciate ligament reconstruction with hamstrings or patella tendon graft: analysis of literature.

    PubMed

    Dauty, M; Tortellier, L; Rochcongar, P

    2005-09-01

    We report isokinetic results of anterior cruciate ligament reconstruction with patellar tendon or hamstring graft from the literature analysis. The literature was defined from two search "textwords": Isokinetic and Anterior cruciate ligament reconstruction, and from three databases: Medline, Pascal, and Herasmus. Two independent physicians (Physical Medicine and Rehabilitation) carried out an analysis according to the French National Accreditation and Health Evaluation Agency recommendations. Fifty-three studies were selected: 29 reported isokinetic results after anterior cruciate ligament reconstruction with patellar tendon graft, 15 reported isokinetic results after anterior cruciate ligament reconstruction with hamstring graft, and 9 studies compared the two surgical procedures. After discussing different bias and in reference to prospective randomised and comparative studies, the anterior cruciate ligament reconstruction with patellar tendon graft involves a knee extensors deficit during several months. The hamstring surgical procedure involves a less important knee extensor deficit (from 6 to 19 % against 8 to 21 %). Knee sprain and intra-articular surgery involve a long-lasting knee extensors deficit. Anterior cruciate ligament reconstruction with hamstrings graft involves a knee flexors deficit over several months. The patellar tendon surgical procedure involves a less important knee flexors deficit (from 1 to 15 % against 5 to 17 %). In reference to isokinetic parameters, no difference between the two surgical procedures (patellar tendon graft or hamstring graft) is shown after more than twenty-four post-surgical months. PMID:16195995

  9. Primary immunolocalization of estrogen and progesterone target cells in the human anterior cruciate ligament.

    PubMed

    Liu, S H; al-Shaikh, R; Panossian, V; Yang, R S; Nelson, S D; Soleiman, N; Finerman, G A; Lane, J M

    1996-07-01

    To identify estrogen and progesterone target cells in the human anterior cruciate ligament immunohistochemical localization of both estrogen and progesterone receptors was performed in 17 specimens of human anterior cruciate ligament. All ligament specimens were obtained at surgery. Thirteen specimens were from women, and four were from men: the average age was 57 years (range, 18-78 years). Eleven specimens (from nine women and two men) came from total knee replacements for osteoarthritis of the knee: three (from two women and one man), from reconstructions of the anterior cruciate ligament: two (both from women), from medial meniscectomies; and one (from a man), from an amputation secondary to chondrosarcoma of the pelvis. An immunoperoxidase method using monoclonal antibodies to the estrogen and progesterone receptors was employed to identify estrogen and progesterone target cells in the anterior cruciate ligament. Staining of both receptors was demonstrable in 14 specimens and in the remaining three specimens less than 15% of the cells were stained. Both estrogen and progesterone receptors were localized to synoviocytes in the synovial lining, fibroblasts in the anterior cruciate ligament stroma and cells in the blood vessel walls of the ligament. This demonstration of receptors for estrogen and progesterone in the cells of anterior cruciate ligament suggests that female sex hormones may have an effect on its structure and composition. PMID:8764860

  10. Femoral Tunnel Placement in Single-Bundle Anterior Cruciate Ligament ReconstructionA Cadaveric Study Relating Transtibial Lateralized Femoral Tunnel Position to the Anteromedial and Posterolateral Bundle Femoral Origins of the Anterior Cruciate Ligament

    Microsoft Academic Search

    John-Paul H. Rue; Neil Ghodadra; Bernard R. Bach

    2008-01-01

    Background: There is controversy regarding the necessity of reconstructing both the posterolateral and anteromedial bundles of the anterior cruciate ligament.Hypothesis: A laterally oriented transtibial drilled femoral tunnel replaces portions of the femoral footprints of the anteromedial and posterolateral bundles of the anterior cruciate ligament.Study Design: Descriptive laboratory study.Methods: Footprints of the anteromedial and posterolateral bundles of the anterior cruciate ligament

  11. Arthroscopic Repair of “Peel-Off” Lesion of the Posterior Cruciate Ligament at the Femoral Condyle

    PubMed Central

    Rosso, Federica; Bisicchia, Salvatore; Amendola, Annunziato

    2014-01-01

    Posterior cruciate ligament (PCL) injuries are uncommon, and most occur in association with other lesions. The treatment of PCL injuries remains controversial; in addition, PCL injuries have been documented to have a propensity to heal. In the literature several different patterns of PCL injury have been described including midsubstance tears/injuries, tibial bony avulsions, femoral bony avulsions, and femoral “peel-off” injuries. A peel-off injury is a complete or incomplete soft-tissue disruption of the PCL at its femoral attachment site without associated bony avulsion. In recent years arthroscopic repair of femoral avulsion and peel-off lesions of the PCL has been reported. In most of these articles, a transosseous repair with sutures passed through 2 bone tunnels into the medial femoral condyle has been described. We present a case of a femoral PCL avulsion in a 20-year-old collegiate football player with an associated medial collateral ligament injury, and we report about a novel technique for PCL repair using 2 No. 2 FiberWire sutures and two 2.9-mm PushLock anchors (Arthrex) to secure tensioning the ligament at its footprint. PMID:24749037

  12. Recent advances following anterior cruciate ligament reconstruction: rehabilitation perspectives : Critical reviews in rehabilitation medicine.

    PubMed

    Manske, Robert C; Prohaska, Daniel; Lucas, Brennen

    2012-03-01

    Injuries to the anterior cruciate ligament are common. Surgical reconstruction is more prevalent than ever. This review article discusses treatment of the patient following surgical reconstruction of the anterior cruciate ligament. Various phases of rehabilitation are discussed with emphasis on early return of passive motion, early weight bearing, bracing, kinetic chain exercises, neuromuscular electrical stimulation and accelerated rehabilitation. Although evidence exists for the treatment of the surgically reconstructed cruciate ligament, more is needed to better define specific timeframes for advancement. Evidence exists that many of these young individuals are not fully returning to unlimited high level activities. This review article presents some of the latest evidence regarding anterior cruciate ligament rehabilitation in an attempt to help the busy clinician understand and relate basic and clinical research to rehabilitation of a patient following reconstruction. PMID:22249750

  13. Anatomical and Nonanatomical Double-Bundle Anterior Cruciate Ligament ReconstructionImportance of Femoral Tunnel Location on Knee Kinematics

    Microsoft Academic Search

    Thore Zantop; Nadine Diermann; Tobias Schumacher; Steffen Schanz; Freddie H. Fu; Wolf Petersen

    2008-01-01

    Background: Studies have suggested that double-bundle anterior cruciate ligament reconstruction may restore intact knee kinematics better than single-bundle anterior cruciate ligament reconstruction. Although the tunnel position of the femoral anteromedial bundle is well established, the effects of different posterolateral bundle positions on knee kinematics are unknown.Hypothesis: Double-bundle anterior cruciate ligament reconstruction with an anatomical (shallow) femoral posterolateral bundle tunnel placement

  14. The mid- to long-term results of the anterior cruciate ligament reconstruction with hamstring tendons using Transfix technique

    Microsoft Academic Search

    Mehmet Asik; Cengiz Sen; Ibrahim Tuncay; Mehmet Erdil; Cem Avci; Omer F. Taser

    2007-01-01

    In this study, mid to long-term results of anterior cruciate ligament reconstruction with hamstring tendons and Transfix technique\\u000a were evaluated. Anterior cruciate ligament (ACL) reconstruction with four-strand hamstring tendon was performed with Transfix\\u000a technique on 271 (198 males, 73 females; mean age 25.7; 17–52) patients with anterior cruciate ligament ruptures. The patients\\u000a were followed up with clinical examination, Lysholm and

  15. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005.

    PubMed

    Griffin, Letha Y; Albohm, Marjorie J; Arendt, Elizabeth A; Bahr, Roald; Beynnon, Bruce D; Demaio, Marlene; Dick, Randall W; Engebretsen, Lars; Garrett, William E; Hannafin, Jo A; Hewett, Tim E; Huston, Laura J; Ireland, Mary Lloyd; Johnson, Robert J; Lephart, Scott; Mandelbaum, Bert R; Mann, Barton J; Marks, Paul H; Marshall, Stephen W; Myklebust, Grethe; Noyes, Frank R; Powers, Christopher; Shields, Clarence; Shultz, Sandra J; Silvers, Holly; Slauterbeck, James; Taylor, Dean C; Teitz, Carol C; Wojtys, Edward M; Yu, Bing

    2006-09-01

    The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group. PMID:16905673

  16. Changes in the Length of Virtual Anterior Cruciate Ligament Fibers During Stability TestingA Comparison of Conventional Single-Bundle Reconstruction and Native Anterior Cruciate Ligament

    Microsoft Academic Search

    Robert H. Brophy; James E. Voos; Fintan J. Shannon; Carinne C. Granchi; Thomas L. Wickiewicz; Russell F. Warren; Andrew D. Pearle

    2008-01-01

    Background: Conventional tunnel positions for single-bundle (SB) transtibial anterior cruciate ligament (ACL) reconstruction are located in the posterolateral (PL) tibial footprint and the anteromedial (AM) femoral footprint, resulting in an anatomic mismatch graft that is more vertical than native fibers. This vertical mismatch position may significantly influence the ability of an ACL graft to stabilize the knee.Hypothesis: Anatomic ACL fibers

  17. Comparison of Single and Double-Bundle Anterior Cruciate Ligament Reconstructions in Restoration of Knee Kinematics and Anterior Cruciate Ligament Forces

    Microsoft Academic Search

    Jong Keun Seon; Hemanth R. Gadikota; Jia-Lin Wu; Karen Sutton; Thomas J. Gill; Guoan Li

    2010-01-01

    Background: Anterior cruciate ligament (ACL) deficiency alters 6 degrees of freedom knee kinematics, yet only anterior translation and internal rotation have been the primary measures in previous studies.Purpose: To compare the 6 degrees of freedom knee kinematics and the graft forces after single- and double-bundle ACL reconstructions under various external loading conditions.Study Design: Controlled laboratory study.Methods: Ten human cadaveric knees

  18. Treating Anterior Cruciate Ligament Tears in Skeletally Immature Patients

    PubMed Central

    Vavken, Patrick; Murray, Martha M

    2011-01-01

    Purpose To systematically review the current evidence for conservative and surgical treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients. Methods A systematic search of PubMed, CINAHL, EMBASE, CCTR, and CDSR was performed for surgical and/or conservative treatment of complete ACL tears in immature individuals. Studies with less than six months of follow-up were excluded. Study quality was assessed and data were collected on clinical outcome, growth disturbance, and secondary joint damage. Results We identified 48 studies meeting the inclusion criteria. Conservative treatment was found to result in poor clinical outcomes and a high incidence of secondary defects, including meniscal and cartilage injury. Surgical treatment had only very weak evidence for growth disturbance, yet strong evidence of good postoperative stability and function. No specific surgical treatment showed clearly superior outcomes, yet the studies using physeal-sparing techniques had no reported growth disturbances at all. Conclusions The current best evidence suggests that surgical stabilization should be considered the preferred treatment in immature patients with complete ACL tears. While physeal-sparing techniques are not associated with a risk of growth disturbance, transphyseal reconstruction is an alternative with a beneficial safety profile and a minimal risk of growth disturbance. Conservative treatment commonly leads to meniscal damage and cartilage destruction and should be considered a last resort. Level of Evidence Level IV, systematic review of Level II, III, and IV studies. PMID:21552340

  19. Complications following anterior cruciate ligament reconstruction in the English NHS.

    PubMed

    Jameson, Simon S; Dowen, Daniel; James, Philip; Serrano-Pedraza, Ignacio; Reed, Mike R; Deehan, David

    2012-01-01

    Unlike the English National Joint Registry (NJR) for arthroplasty, no surgeon driven national database currently exists for ligament surgery in England. Therefore information on outcome and adverse events following anterior cruciate ligament (ACL) surgery is limited to case series. This restricts the ability to make formal recommendations upon surgical care. Prospectively collected data, which is routinely collected on every NHS patient admitted to hospital in England, was analysed to determine national rates of 90-day symptomatic deep venous thrombosis (DVT), pulmonary thromboembolism (PTE) rate, 30-day wound infection and readmission rates following primary ACL reconstruction between March 2008 and February 2010 (13,941 operations, annual incidence 13.5 per 100,000 English population). 90-day DVT and PTE rates were 0.30% (42) and 0.18% (25) respectively. There were no in-hospital deaths. 0.75% (104) of the consecutive patient cohort had a wound complication recorded. 0.25% (35) underwent a further procedure to wash out the infected knee joint and 1.36% (190) were readmitted to an orthopaedic ward within 30days. This is the first national comprehensive study of the incidence of significant complications following ACL surgery in England. This should allow meaningful interpretation of future baseline data supporting the development of a national ligament registry. PMID:21216599

  20. Cryopreserved anterior cruciate ligament allografts in a canine model.

    PubMed

    Kirkpatrick, J S; Seaber, A V; Glisson, R R; Bassett, F H

    1996-01-01

    This study was done to determine the clinical and biomechanical properties of cryopreserved anterior cruciate ligament allografts at 3, 6, 9, and 24 months after transplantation. A companion study of autografts was done to evaluate the effects of the surgical procedure and preservation on the tissue. The knee joints of 69 mongrel dogs (allograft n = 34, autograft n = 35) weighing 17 kg to 25 kg were grafted. Biomechanical results showed that maximum load was less in allografts than in autografts at each time interval. Deformation and slope were not significantly different between allograft and autograft. An apparent delay in revascularization and cellular repopulation was found in allografts compared with autografts, and collagen type I/type III ratios were similar in both grafts. DNA analysis indicated complete replacement of DNA in the graft by the host. Allografts provide adequate functional stability for daily activities in the canine model up to 2 years after transplantation. Biomechanical properties were relatively poor in allografts, which may lead to failure under more strenuous activity. The biologic similarity to autografts may indicate future remodeling potential. PMID:8673586

  1. Anterior cruciate ligament injuries: diagnosis, treatment, and prevention.

    PubMed

    LaBella, Cynthia R; Hennrikus, William; Hewett, Timothy E

    2014-05-01

    The number of anterior cruciate ligament (ACL) injuries reported in athletes younger than 18 years has increased over the past 2 decades. Reasons for the increasing ACL injury rate include the growing number of children and adolescents participating in organized sports, intensive sports training at an earlier age, and greater rate of diagnosis because of increased awareness and greater use of advanced medical imaging. ACL injury rates are low in young children and increase sharply during puberty, especially for girls, who have higher rates of noncontact ACL injuries than boys do in similar sports. Intrinsic risk factors for ACL injury include higher BMI, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of knee motion. ACL injuries often require surgery and/or many months of rehabilitation and substantial time lost from school and sports participation. Unfortunately, regardless of treatment, athletes with ACL injuries are up to 10 times more likely to develop degenerative arthritis of the knee. Safe and effective surgical techniques for children and adolescents continue to evolve. Neuromuscular training can reduce risk of ACL injury in adolescent girls. This report outlines the current state of knowledge on epidemiology, diagnosis, treatment, and prevention of ACL injuries in children and adolescents. PMID:24777218

  2. Rehabilitation After Anterior Cruciate Ligament Reconstruction in the Female Athlete

    PubMed Central

    Wilk, Kevin E.; Arrigo, Christopher; Andrews, James R.; Clancy, William G.

    1999-01-01

    Objective: To discuss the rehabilitation program after anterior cruciate ligament (ACL) reconstruction in the female athlete. In addition, we will discuss 8 unique characteristics identified in the female athlete and specific training drills to address and correct the potentially deleterious effects of these unique characteristics. Background: The female athlete appears to be more susceptible to noncontact ACL injuries than the male athlete. There seem to be many differences between the female and male athlete that may contribute to the increased injury rate in the female athlete. These variations include anatomical and neuromuscular considerations and differences. Description: Based on the unique characteristics of the female athlete and the anatomical and neuromuscular dissimilarities, a specially designed rehabilitation program has been established for the female athlete after ACL surgery. Clinical Advantages: The rehabilitation drills discussed in this article challenge the neuromuscular system through proprioception, kinesthesia, dynamic joint stability, neuromuscular control, and perturbation training activities. Improving the female athlete's neuromuscular system will, we believe, expedite the injured athlete's recovery after ACL injury or surgery. Although the concepts discussed are part of a postoperative rehabilitation program after ACL surgery, these concepts may also be implemented as a preventive program to assist in reducing the incidence of ACL injuries in the female athlete. ImagesFigure 1.Figure 2.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10.Figure 11.Figure 12.Figure 13.Figure 14.Figure 15.Figure 16.Figure 17.Figure 18.Figure 19.Figure 20.Figure 21.Figure 22.Figure 23. PMID:16558561

  3. Graft selection in anterior cruciate ligament reconstruction--prospective analysis of patellar tendon autografts compared with allografts.

    PubMed

    Victor, J; Bellemans, J; Witvrouw, E; Govaers, K; Fabry, G

    1997-01-01

    A prospective study of 73 arthroscopic anterior cruciate ligament reconstructions using either a patellar tendon autograft or an allograft was made to assess any difference in clinical outcome. Allocation was by availability of an allograft. There were 48 autografts and 25 allografts. Evaluation was by clinical examination and physical tests. At follow-up 2 years after operation, there were no statistically significant differences between the two groups in mobility or in physical tests, but KT-1000 evaluation showed a slightly greater anterior translation in the autografts at 6 months and one year, although at 2 years the allografts developed greater anterior laxity. Cybex testing showed greater quadriceps strength at 6 months and one year in the allografts, but at 2 years the strength was greater in the autografts. Re-rupture occurred in 3 allografts. ACL reconstruction with a patellar tendon allograft does not produce a significant functional deficit. Full quadriceps recovery takes 2 years. Allografts are not recommended as stability deteriorates with time. PMID:9195261

  4. Graft failure in intra-articular anterior cruciate ligament reconstructions: A review of the literature

    Microsoft Academic Search

    Anil Vergis; Jan Gillquist

    1995-01-01

    There exists a substantial group of patients with unsatisfactory results following anterior cruciate ligament (ACL) reconstructions. This may be attributable to graft failure. Revision surgery, for the correction of abnormal anterior translation or laxity, requires a careful analysis of the causes of failure to ensure the success of the salvage procedure. This review attempts to present an overview of some

  5. Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft

    Microsoft Academic Search

    Keith L. Markolf; Sharon Hame; D. Monte Hunter; Daniel A. Oakes; Bojan Zoric; Paul Gause; Gerald A. M. Finerman

    2002-01-01

    The purpose of this study was to measure the effects of variation in placement of the femoral tunnel upon knee laxity, graft pretension required to restore normal anterior–posterior (AP) laxity and graft forces following anterior cruciate ligament (ACL) reconstruction. Two variants in tunnel position were studied: (1) AP position along the medial border of the lateral femoral condyle (at a

  6. Anatomical study of the human anterior cruciate ligament stump’s tibial insertion footprint

    Microsoft Academic Search

    András Tállay; Mui-Hong Lim; John Bartlett

    2008-01-01

    The aim of this study is to define the topographical relationship of the anatomical bundles of the human anterior cruciate\\u000a ligament’s (ACL) stump over the tibial insertion site. Between January and April 2007, a total of 36 resected tibial plateaus\\u000a were retrieved from patients who underwent total knee replacements. These samples had intact cruciate ligaments with no major\\u000a osteophyte around

  7. Effects of Applied Quadriceps and Hamstrings Muscle Loads on Forces in the Anterior and Posterior Cruciate Ligaments

    Microsoft Academic Search

    Keith L. Markolf; Geoffery O’Neill; Steven R. Jackson; David R. McAllister

    2004-01-01

    Background: Muscle contraction can subject healing knee ligament grafts to high loads.Purpose: To directly measure the effects of quadriceps and hamstrings muscle loads on forces in the anterior cruciate ligaments and posterior cruciate ligaments.Study Design: Controlled laboratory study.Methods: Thirteen cadaveric knee specimens had load cells installed to record resultant forces in both anterior and posterior cruciate ligaments under 5 loading

  8. Infections and Patellar Tendon Ruptures After Anterior Cruciate Ligament ReconstructionA Comparison of Ipsilateral and Contralateral Patellar Tendon Autografts

    Microsoft Academic Search

    Rodney W. Benner; K. Donald Shelbourne; Heather Freeman

    2011-01-01

    Background: No studies document the incidence or results of infections and patellar tendon ruptures after anterior cruciate ligament reconstruction with a contralateral patellar tendon autograft.Purpose: To determine the results of patients who have infections and patellar tendon ruptures after anterior cruciate ligament reconstruction with a patellar tendon autograft and compare the results between ipsilateral and contralateral grafts.Study Design: Cohort study;

  9. The Relative Incidence of Anterior Cruciate Ligament Injury in Men and Women at the United States Naval Academy

    Microsoft Academic Search

    David E. Gwinn; John H. Wilckens; Edward R. McDevitt; Glen Ross; Tzu-Cheg Kao

    2000-01-01

    The purpose of this study was to evaluate the relative risk of anterior cruciate ligament injury in female versus male midshipmen at the United States Naval Academy. From 1991 to 1997, we recorded the incidence of anterior cruciate ligament injury during intercollegiate athletics, intramural athletics, and military training. The subjects were male and female varsity athletes, coed intramural athletes, and

  10. Sex, Collagen Expression, and Anterior Cruciate Ligament Strength in Rats

    PubMed Central

    Romani, William A.; Langenberg, Patricia; Belkoff, Stephen M.

    2010-01-01

    Abstract Context: Sex-specific responses to steroid sex hormones have been suggested as a potential cause for the disparate anterior cruciate ligament (ACL) injury rates between male and female athletes. Type 1 collagen (T1C) and type 3 collagen (T3C) are crucial structural components that define the ligament's ability to withstand tensile loads. Messenger RNA (mRNA) is an important mediator of downstream collagen synthesis and remodeling, but the sex-specific mechanisms of collagen mRNA expression and ACL strength are unknown. Objective: To examine the influence of sex on T1C and T3C mRNA expression and mass-normalized stiffness and peak failure load in the ACLs of skeletally mature rats. Design: Observational study. Setting: Basic sciences and biomechanical testing laboratories. Patients or Other Participants: Nineteen 12-week-old male (n ?=? 9) and female (n ?=? 10) Sprague Dawley rats. Main Outcome Measure(s): We used real-time polymerase chain reaction to determine T1C and T3C mRNA expression and a hydraulic materials testing device to measure ACL stiffness and failure load. Nonparametric Wilcoxon rank sum tests were used to compare the groups. Results: Female rats had lower amounts of T3C mRNA expression and higher normalized ACL tangent stiffness and failure load than male rats. Conclusions: These findings suggest that sex-specific differences in T1C and T3C mRNA expression may play an important role in the downstream mechanical properties of the ACL. PMID:20064044

  11. Autograft Versus Nonirradiated Allograft Tissue for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Mariscalco, Michael W.; Magnussen, Robert A.; Mehta, Divyesh; Hewett, Timothy E.; Flanigan, David C.; Kaeding, Christopher C.

    2014-01-01

    Background An autograft has traditionally been the gold standard for anterior cruciate ligament reconstruction (ACLR), but the use of allograft tissue has increased in recent years. While numerous studies have demonstrated that irradiated allografts are associated with increased failure rates, some report excellent results after ACLR with nonirradiated allografts. The purpose of this systematic review was to determine whether the use of nonirradiated allograft tissue is associated with poorer outcomes when compared with autografts. Hypothesis Patients undergoing ACLR with autografts versus nonirradiated allografts will demonstrate no significant differences in graft failure risk, laxity on postoperative physical examination, or differences in patient-oriented outcome scores. Study Design Systematic review. Methods A systematic review was performed to identify prospective or retrospective comparative studies (evidence level 1, 2, or 3) of autografts versus nonirradiated allografts for ACLR. Outcome data included graft failure based on clinical findings and instrumented laxity, postoperative laxity on physical examination, and patient-reported outcome scores. Studies were excluded if they did not specify whether the allograft had been irradiated. Quality assessment and data extraction were performed by 2 examiners. Results Nine studies comparing autografts and nonirradiated allografts were included. Six of the 9 studies compared bone– patellar tendon–bone (BPTB) autografts with BPTB allografts. Two studies compared hamstring tendon autografts to hamstring tendon allografts, and 1 study compared hamstring tendon autografts to tibialis anterior allografts. The mean patient age in 7 of 9 studies ranged from 24.5 to 32 years, with 1 study including only patients older than 40 years and another not reporting patient age. The mean follow-up duration was 24 to 94 months. Six of 9 studies reported clinical graft failure rates, 8 of 9 reported postoperative instrumented laxity measurements, 7 of 9 reported postoperative physical examination findings, and all studies reported patient-reported outcome scores. This review demonstrated no statistically significant difference between autografts and nonir-radiated allografts in any outcome measure. Conclusion No significant differences were found in graft failure rate, postoperative laxity, or patient-reported outcome scores when comparing ACLR with autografts to nonirradiated allografts in this systematic review. These findings apply to patients in their late 20s and early 30s. Caution is advised when considering extrapolation of these findings to younger, more active cohorts. PMID:23928319

  12. Experimental and Numerical Analysis of Screw Fixation in Anterior Cruciate Ligament Reconstruction

    NASA Astrophysics Data System (ADS)

    Chizari, Mahmoud; Wang, Bin; Snow, Martyn; Barrett, Mel

    2008-09-01

    This paper reports the results of an experimental and finite element analysis of tibial screw fixation in anterior cruciate ligament (ACL) reconstruction. The mechanical properties of the bone and tendon graft are obtained from experiments using porcine bone and bovine tendon. The results of the numerical study are compared with those from mechanical testing. Analysis shows that the model may be used to establish the optimum placement of the tunnel in anterior cruciate ligament reconstruction by predicting mechanical parameters such as stress, strain and displacement at regions in the tunnel wall.

  13. Management of septic arthritis following anterior cruciate ligament reconstruction: a review of current practices and recommendations.

    PubMed

    Cadet, Edwin R; Makhni, Eric C; Mehran, Nima; Schulz, Brian M

    2013-11-01

    Septic arthritis following anterior cruciate ligament reconstruction is a rare and potentially devastating complication that often leads to articular destruction and adverse clinical outcomes. Because of its rare occurrence, best practices for diagnosis and management have yet to be established. However, graft retention and favorable outcomes are possible with early diagnosis, surgical intervention, and appropriate antibiotic management. Clinicians must be familiar with the diagnostic criteria and management options for septic arthritis. Most patients require multiple procedures to effectively eradicate infection. When the original reconstructed graft cannot be salvaged, a staged anterior cruciate ligament reconstruction revision is required. PMID:24187034

  14. Preparing a female collegiate athlete for anterior cruciate ligament reconstruction and rehabilitation.

    PubMed

    Leech, Edward

    2003-01-01

    An anterior cruciate ligament injury is common among athletes involved in sports where cutting or sudden changes of position occur. This is a case study of a female collegiate athlete who sustained an anterior cruciate ligament injury, with a small meniscus tear, and decides on a course of surgery. Questions she has about the initial injury, as well as subsequent questions concerning reconstructive surgery using a patellar graft and the course of rehabilitation, are answered. A chart of her rehabilitation protocol is provided. PMID:12803146

  15. Effect of Single-Bundle and Double-Bundle Anterior Cruciate Ligament Reconstructions on Pivot-Shift Kinematics in Anterior Cruciate Ligament and Meniscus-Deficient Knees

    Microsoft Academic Search

    Volker Musahl; Asheesh Bedi; Musa Citak; Padhraig OLoughlin; Daniel Choi; Andrew D. Pearle

    2011-01-01

    Background: Recent laboratory and clinical studies report no difference between single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction.Hypothesis: Anatomical DB ACL reconstruction would restore knee kinematics in a complex injury model of ACL—meniscus injury closer to the intact state when compared with 2 common SB ACL reconstructions.Study Design: Controlled laboratory study.Methods: Five fresh-frozen cadaveric hip-to-toe lower extremity specimens

  16. Anterior cruciate ligament reconstruction: endoscopic versus two-incision technique.

    PubMed

    Harner, C D; Marks, P H; Fu, F H; Irrgang, J J; Silby, M B; Mengato, R

    1994-10-01

    The purpose of this study was to compare the single-incision, "endoscopic" (ENDO) anterior cruciate ligament (ACL) reconstruction technique with the two-incision, "rear-entry" technique (RE). Sixty patients were entered into a prospective study. Thirty patients underwent ACL reconstruction by the RE technique, followed by 30 consecutive patients using the ENDO procedure. Postoperatively all patients followed a standardized rehabilitation protocol. Follow-up evaluation consisted of a detailed physical examination, range of motion, thigh girth, vertical leap, hop test, KT-1000 testing, and patient interview. They were scored according to the International Knee Documentation Committee (IKDC) protocol, which takes objective and subjective data into account. Patients were also assessed for level of sports activity including frequency and type. Finally, anteroposterior and lateral x-ray films were evaluated with a scoring system for tunnel location. Of the initial 60 patients entered into the study, 50 were available for a detailed clinical and functional review (83%). Demographic comparisons revealed 24 RE patients and 26 ENDO patients. There were 16 men and 8 women in the RE group. The ENDO group comprised 16 men and 10 women. There were 14 right knees and 10 left knees in the RE group. In the ENDO group there were 13 right knees and 13 left knees. The average age in the RE group was 24 years and 25 years in the ENDO group. The average follow-up was 35 months (range 31-40 months) in the RE group and 29 months (range 24-35 months) in the ENDO group. Complications included two patients with loss of motion in the RE group and three in the ENDO group. There were no significant differences between the two groups tested with respect to the overall IKDC rating scale. Anteroposterior and lateral x-ray films revealed no significant differences in femoral and tibial tunnel placement. In conclusion, no significant functional or radiographic differences at a minimum 2-year follow-up could be identified when comparing the two ACL reconstructive techniques. PMID:7999157

  17. Outcome of Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review

    PubMed Central

    Wright, Rick W.; Gill, Corey S.; Chen, Ling; Brophy, Robert H.; Matava, Matthew J.; Smith, Matthew V.; Mall, Nathan A.

    2012-01-01

    Background: Revision anterior cruciate ligament (ACL) reconstruction is believed to have an inferior outcome compared with primary ACL reconstruction. The available literature on the outcome of revision ACL reconstruction is sparse compared with that for primary reconstruction. The purpose of this systematic review was to test the hypothesis that the outcome of revision ACL reconstruction compares unfavorably with the historical outcome of primary ACL reconstruction. Methods: A systematic review of studies evaluating the outcome of revision ACL reconstructions with a minimum of two years of follow-up was performed. Pooled data were collected when appropriate and a mixed-effect-model meta-analysis was performed for important outcome measures that were reported in several studies (objective graft failure, Lysholm score, International Knee Documentation Committee [IKDC] subjective score, and IKDC objective score). Objective failure was defined as repeat revision, a side-to-side difference of >5 mm measured with use of a KT1000 arthrometer, or a pivot-shift grade of 2+ or 3+. Results: Twenty-one studies were included, and 863 of the 1004 patients in these studies had a minimum of two years of follow-up and were analyzed. The pooled mean age of the patients at the time of the revision procedure was 30.6 years, and 66% were male. Objective failure occurred in 13.7% ± 2.7% of the patients (95% confidence interval, 8.0% to 19.4%). The mean Lysholm score in 491 patients was 82.1 ± 3.3 (95% confidence interval, 74.6 to 89.5) according to a mixed-model meta-analysis. The mean IKDC subjective score in 202 patients was 74.8 ± 4.4 (95% confidence interval, 62.5 to 87.0). Conclusions: Revision ACL reconstruction resulted in a worse outcome compared with primary ACL reconstruction. Patient-reported outcome scores were inferior to previously published results of primary ACL reconstruction, but these differences may not be clinically important. A dramatically elevated failure rate was noted after revision ACL reconstruction; this rate was nearly three to four times the failure rate in prospective series of primary ACL reconstructions. PMID:22438002

  18. Knee Rotational Laxity in a Randomized Comparison of Single Versus Double-Bundle Anterior Cruciate Ligament Reconstruction

    Microsoft Academic Search

    Andrea Hemmerich; Willem van der Merwe; Marijka Batterham; Christopher L. Vaughan

    2011-01-01

    Background: While single-bundle anterior cruciate ligament reconstruction reduces anterior-posterior laxity, studies have demonstrated residual rotational instability. Improved pivot-shift results have been shown with the double-bundle graft; however, no study has compared rotational laxity outcome of these surgical techniques in vivo under quantified, isolated torsional loading.Hypothesis: The anterior cruciate ligament—deficient knee exhibits greater rotational laxity than the contralateral uninjured knee. The

  19. Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects: A Cross-sectional Study

    PubMed Central

    Mir, Seyed Mohsen; Talebian, Saeed; Naseri, Nasrin; Hadian, Mohammad-Reza

    2014-01-01

    [Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint position sense in a manner relevant to the mechanism of injury. Therefore, the aim of this study was to measure knee joint position sense in the noncontact anterior cruciate ligament injury risk position and normal condition. [Subjects and Methods] Thirty healthy male athletes participated in the study. Joint position sense was evaluated by active reproduction of the anterior cruciate ligament injury risk position and normal condition. The dominant knees of subjects were tested. [Results] The results showed less accurate knee joint position sense in the noncontact anterior cruciate ligament injury risk position rather than the normal condition. [Conclusion] The poorer joint position sense in non-contact anterior cruciate ligament injury risk position compared with the normal condition may contribute to the increased incidence of anterior cruciate ligament injury. PMID:25364100

  20. Prevention of Arthrofibrosis After Anterior Cruciate Ligament Reconstruction Using the Central Third Patellar Tendon Autograft

    Microsoft Academic Search

    Andrew J. Cosgarea; Wayne J. Sebastianelli; Kenneth E. DeHaven

    1995-01-01

    A retrospective analysis was performed to explain the decreasing incidence of postoperative arthrofibrosis of the knee in 191 consecutive patients who had anterior cruciate ligament reconstruction using the central third patellar tendon from 1987 through 1991. Follow-up data were available on 188 patients (98%). Age, sex, time interval from injury, preoperative motion, and concomi tant meniscal repair or partial meniscectomy

  1. Sex-based differences in the tensile properties of the human anterior cruciate ligament

    Microsoft Academic Search

    Naveen Chandrashekar; Hossein Mansouri; James Slauterbeck; Javad Hashemi

    2006-01-01

    After immense amounts of research, the root cause for the significantly higher rates of anterior cruciate ligament (ACL) failure incidents in females as compared to males still remains unknown and the existing sex-based disparity has not diminished. To date, the possibility that the female ACL is mechanically weaker than the male ACL has not been directly investigated. Although it has

  2. Implementation of Open and Closed Kinetic Chain Quadriceps Strengthening Exercises after Anterior Cruciate Ligament Reconstruction.

    ERIC Educational Resources Information Center

    Ross, Michael D.; Denegar, Craig R.; Winzenried, Jay A.

    2001-01-01

    Reviews the effects of open kinetic chain (OKC) and closed kinetic chain (CKC) exercise on anterior cruciate ligament (ACL) strain and patellofemoral joint stress, suggesting a combination of the two for quadriceps strengthening after ACL reconstruction. Both OKC and CKC exercises may be modified and implemented for quadriceps strengthening after…

  3. Reconstruction of patellar tendon rupture after anterior cruciate ligament reconstruction: A case report

    Microsoft Academic Search

    Milankov Ziva Miroslav; Semnic Robert; Miljkovi? Natasa; Harhaji Vladimir

    2008-01-01

    Patellar tendon rupture following use of its central third for anterior cruciate ligament (ACL) reconstruction is a rare disabling injury that is technically difficult to repair. We report one case of patellar tendon rupture after harvesting the mid-third for ACL reconstruction. A number of different surgical methods exist for reconstructing patellar tendon ruptures. Here we report a case using a

  4. Anatomic Single and Double-Bundle Anterior Cruciate Ligament Reconstruction Flowchart

    Microsoft Academic Search

    Carola F. van Eck; Bryson P. Lesniak; Verena M. Schreiber; Freddie H. Fu

    2010-01-01

    Anatomy is the foundation of orthopaedic surgery, and the advancing knowledge of the anterior cruciate ligament (ACL) anatomy has led to the development of improved modern reconstruction techniques that approach the anatomy of the native ACL. Current literature on the anatomy of the ACL and its reconstruction techniques, as well as our surgical experience, was used to develop a flowchart

  5. Anterior Cruciate Ligament Reconstruction and Preservation: The Single-Anteromedial Bundle Biological Augmentation (SAMBBA) Technique.

    PubMed

    Sonnery-Cottet, Bertrand; Freychet, Benjamin; Murphy, Colin G; Pupim, Barbara H B; Thaunat, Mathieu

    2014-12-01

    Preservation of the anterior cruciate ligament (ACL) remnant during ACL reconstruction has the advantages of improved vascularity and synovial encircling of the graft tendon. We describe a technique called single-anteromedial bundle biological augmentation (SAMBBA) using complete preservation of the ACL remnant, as well as preservation of the semitendinosus tibial insertion, that uses standard portals and equipment. PMID:25685675

  6. Knee stability assessment on anterior cruciate ligament injury: Clinical and biomechanical approaches

    Microsoft Academic Search

    Mak-Ham Lam; Daniel TP Fong; Patrick SH Yung; Eric PY Ho; Wood-Yee Chan; Kai-Ming Chan

    2009-01-01

    Anterior cruciate ligament (ACL) injury is common in knee joint accounting for 40% of sports injury. ACL injury leads to knee instability, therefore, understanding knee stability assessments would be useful for diagnosis of ACL injury, comparison between operation treatments and establishing return-to-sport standard. This article firstly introduces a management model for ACL injury and the contribution of knee stability assessment

  7. Central Quadriceps Tendon for Anterior Cruciate Ligament ReconstructionPart I: Morphometric and Biomechanical Evaluation

    Microsoft Academic Search

    N. Lindsay Harris; David A. B. Smith; Lisa Lamoreaux; Mark Purnell

    1997-01-01

    We examined the anatomic and biomechanical adequacy of the central quadriceps tendon as an al ternative graft source for anterior cruciate ligament reconstruction. Morphometry was performed on 15 preserved and 6 fresh-frozen specimens. Biomechani cal testing was performed on the six fresh-frozen spec imens. We initially used a triple suture through the tendon construction, and then clamping directly on the

  8. Initial fixation strength of polylactic acid interference screws in anterior cruciate ligament reconstruction

    Microsoft Academic Search

    JA Abate; PD Fadale; MJ Hulstyn; WR Walsh

    1998-01-01

    The initial fixation properties of bioresorbable polylactic acid (PLA) interference screws designed for anterior cruciate ligament reconstruction were evaluated using an in vitro bovine model. The surgical technique of interference screw fixation of the bone-patellar tendon-bone autograft complex performed clinically was reproduced in an adult bovine model. The reconstructed knee was tested oriented in 30 degrees of flexion to allow

  9. Tibial Tunnel Placement in Anterior Cruciate Ligament Reconstructions and Graft Impingement

    Microsoft Academic Search

    MAJ STEPHEN M. HOWELL; JAMES A. CLARK

    1992-01-01

    Fifty-six anterior cruciate ligament (ACL) reconstructions had a magnetic resonance scan of the ACL graft six months after operation. The impingement-free grafts (n = 26) had a low mag- netic resonance signal from origin to insertion. Impinged grafts (n = 30) had an increased mag- netic resonance signal confined to the distal two thirds of the graft. The location of

  10. An analysis method of endobutton position with registration in MDCT images after anterior cruciate ligament reconstruction

    Microsoft Academic Search

    Y. Uozumi; K. Nagamune; D. Araki; S. Kubo; R. Kuroda; M. Kurosaka

    2010-01-01

    ACL (Anterior Cruciate Ligament) reconstruction is performed to recover the injured knee which often happens in sports activity such as skiing, and basketball. The ACL reconstruction makes one or two bone tunnel(s) in the femur and tibia. Then, the harvested graft passes the bone tunnels so that the femur and tibia are connected. The graft is fixed to the femur

  11. An Evaluation Method of EndoButton Position in MDCT Image After Anterior Cruciate Ligament Reconstruction

    Microsoft Academic Search

    Kouki Nagamune; Daisuke Arake; Koji Nishimot; Yuichi Hoshino; Seiji Kubo; Ryosuke Kuroda; Mashiro Kurosaka

    2009-01-01

    Anterior Cruciate Ligament (ACL) reconstruction is performed to recover the injured knee which often happens in sports activity such as skiing, and basketball. The ACL reconstruction makes two bone tunnels in the femur and tibia. Then, the harvested graft passes the bone tunnels so that the femur and tibia are connected. The graft is fixed to the femur by using

  12. Evaluation of Single-Leg Standing Following Anterior Cruciate Ligament Surgery and Rehabilitation

    Microsoft Academic Search

    Elkabeth L Harrison; Nlcky Duenkel; Robert Dunlop; Gordon Russell

    Backpund and Purpose. Although surgical reconstruction of the anterior cruciate ligament (ACL) is commonly peormed to increase stability of the knee, penistent changes in neuromuscular function have frequently been cited as con- tributing to disability. This study investigated single-leg standing balance in a (ACL) of the knee is commonly diag- thesia of the knee joint will be de- may contribute

  13. Comparison of tunnel positions in single-bundle anterior cruciate ligament reconstructions using computer navigation

    Microsoft Academic Search

    James E. Voos; Volker Musahl; Travis G. Maak; Thomas L. Wickiewicz; Andrew D. Pearle

    2010-01-01

    Recurrent rotational instability has been identified as a potential source of failure of anterior cruciate ligament (ACL)\\u000a reconstructions. The aim of the study was to assess whether knee kinematics in the horizontal configuration more closely resemble\\u000a the intact knee when compared with other single-bundle configurations. Using the Praxim computer navigation system, ACL reconstructions\\u000a were performed with tibialis anterior grafts in

  14. Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction

    PubMed Central

    Lu, Daifeng; Xiao, Mochao; Lian, Yongyun; Zhou, Yong; Liu, Xuefeng

    2014-01-01

    Objective: To perform dual-bundle reconstruction of posterior cruciate ligament using full arthroscopic tibial inlay technology with self-designed tibia tunnel drilling system and to compare the effect of arthroscopic tibial inlay versus traditional technique for posterior cruciate ligament reconstruction. Material and methods: 32 patients were randomly divided into experiment group (improved tibial inlay, n = 17) and control group (traditional tibial inlay, n = 15). Self-designed tibia tunnel drill system was used to produce intraoperative deep-limited bone tunnel. During follow-up, the location of the bone block and the healing situation were checked by knee X-ray and spiral CT scan. Blood loss, operation time and nerve vascular injuries were evaluated. Results: Mean intraoperative blood loss was 123.53 ± 74.05 ml in the improved tibial inlay group compared with 332 ± 114.26 ml in the traditional tibial inlay group (t = 6.12, P < 0.05). Mean operation time was 235.27 ± 58.88 min in the improved tibial inlay group compared with 346.37 ± 59.67 min in the traditional tibial inlay group (t = 5.19, P < 0.05). Posterior drawer test were negative in 15 cases, slight positive in 2 with improved tibial inlay technique compared with 14 negative cases and 2 positive cases of traditional tibial Inlay technique. The X-ray and spiral CT scan showed the location of the bone block were perfect and healed well with the patent who received improved tibial inlay technology after 12 weeks postoperatively. Conclusion: Accurate depth-limited bone tunnel can be produced by the tibia tunnel drill system with minor trauma, less bleeding and reducing of nerves or vessels and the recent clinical effects of PCL reconstruction were pretty good. PMID:25419349

  15. Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

    PubMed Central

    Ahn, Jin Hwan; Lee, Yong Seuk; Lee, Seung Hee

    2014-01-01

    We established a method for creation of an anatomic femoral tunnel with minimal damage to the remnant bundle in remnant-preserving anterior cruciate ligament (ACL) reconstruction. The goals of this surgical technique were to preserve the remnant bundle as much as possible, especially at the femoral insertion, and to make the tunnel at the anatomic position. The critical points are that the posterior side of the femoral footprint of the ACL is observed through the posterolateral portal using a 70° arthroscope and a femoral tunnel is made by use of an outside-in technique with remnant preservation. This technique allows for easy viewing of the posterior side of the ACL and enables performance of an anatomic ACL reconstruction. PMID:24749041

  16. Role of the Medial Structures in the intact and Anterior Cruciate Ligament-Deficient KneeLimits of Motion in the Human Knee

    Microsoft Academic Search

    Jonathan L. Haimes; Randall R. Wroble; Edward S. Grood; Frank R. Noyes

    1994-01-01

    We measured motion limits in human cadaveric knees before and after sectioning the anterior cruciate liga ment and the medial structures. Sectioning the medial collateral ligament in an anterior cruciate ligament- deficient knee increased the anterior translation limit at 90° of flexion but not at 30° of flexion. The tibia displaced straight anteriorly without exhibiting the coupled internal rotation that

  17. Single-Tunnel Double-Bundle Anterior Cruciate Ligament Reconstruction With Anatomical Placement of Hamstring Tendon GraftCan It Restore Normal Knee Joint Kinematics?

    Microsoft Academic Search

    Hemanth R. Gadikota; Jia-Lin Wu; Jong Keun Seon; Karen Sutton; Thomas J. Gill; Guoan Li

    2010-01-01

    Background: Anatomical reconstruction techniques that can restore normal joint kinematics without increasing surgical complications could potentially improve clinical outcomes and help manage anterior cruciate ligament injuries more efficiently.Hypothesis: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can more closely restore normal knee anterior-posterior, medial-lateral, and internal-external kinematics than can conventional single-bundle anterior cruciate ligament reconstruction.Study

  18. Potential commercial application of a bi-layer bone-ligament regeneration scaffold to anterior cruciate ligament replacement

    E-print Network

    Li, Jessica C. (Jessica Ching-Yi)

    2006-01-01

    A business model was created in order to explore the commercial application of a bi-layer bone-ligament scaffold to the treatment of torn anterior cruciate ligaments (ACL) requiring replacement. The two main keys in producing ...

  19. What is the role of the conservative intervention in the treatment of a torn anterior cruciate ligament?

    PubMed

    Atik, O ?ahap

    2015-08-01

    Anterior cruciate ligament (ACL) injuries are common and the economic burden of these injuries is high. However, the optimal management of a torn ACL of the knee is still controversial. Anterior cruciate ligament surgery is not suitable for all patients; there are some indications for non-surgical treatment with a strict neuromuscular rehabilitation program in selected patients. Neuromuscular rehabilitation is also necessary prior to ACL reconstruction. This is crucial for the primary and secondary prevention, too. PMID:26165713

  20. Gender-Based Differences in Outcome After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts

    Microsoft Academic Search

    Harukazu Tohyama; Eiji Kondo; Riku Hayashi; Nobuto Kitamura; Kazunori Yasuda

    2011-01-01

    Background: Although previous studies suggested that female patients are predisposed to increase graft laxity compared with male patients after single-bundle anterior cruciate ligament reconstruction using autogenous hamstring tendons, there have been no studies specifically examining gender-based differences in outcome after anatomic double-bundle anterior cruciate ligament reconstruction with hamstring tendon autografts.Hypotheses: (1) Female patients have significantly smaller hamstring graft diameters than

  1. The Effects of Different Tensioning Strategies on Knee Laxity and Graft Tension After Double-Bundle Anterior Cruciate Ligament Reconstruction

    Microsoft Academic Search

    Pierluigi Cuomo; Krishna Reddi Boddu Siva Rama; Anthony M. J. Bull; Andrew A. Amis

    2007-01-01

    Background: Double-bundle anterior cruciate ligament reconstruction replicates the 2 functional bundles of the native ligament, the posterolateral and the anteromedial, to control anteroposterior and rotational laxity.Hypothesis: Double-bundle anterior cruciate ligament reconstruction laxity should be affected by the way grafts are tensioned.Study Design: Controlled laboratory study.Methods: Fourteen intact cadaveric knees were instrumented in a 6 degree of freedom rig, and kinematics

  2. Percutaneous ultrasound-guided aspiration of an anterior cruciate ligament ganglion cyst: description of technique and case presentation.

    PubMed

    Krill, Michael; Peck, Evan

    2014-12-01

    An anterior cruciate ligament ganglion cyst is an infrequent but potentially clinically significant cause of knee pain. Although the cyst may be removed surgically, percutaneous ultrasound-guided anterior cruciate ligament ganglion cyst aspiration and injection is feasible. To our knowledge, we present the first reported case description of the utilization of ultrasound guidance to perform this procedure with a successful clinical outcome. PMID:25088315

  3. Does wearing a functional knee brace affect hamstring reflex time in subjects with anterior cruciate ligament deficiency during muscle fatigue?

    Microsoft Academic Search

    Rita Y. Lam; Gabriel Y. Ng; Eric P. Chien

    2002-01-01

    Lam RY, Ng GY, Chien EP. Does wearing a functional knee brace affect hamstring reflex time in subjects with anterior cruciate ligament deficiency during muscle fatigue? Arch Phys Med Rehabil 2002;83:1009-12. Objective: To evaluate the effects of wearing a functional knee brace and muscle fatigue on hamstring reflex time in subjects with anterior cruciate ligament (ACL) deficiency. Design: Repeated-measures clinical

  4. Anterior Cruciate Ligament Femoral Socket Drilling With a Retrograde Reamer: Lessons From the Learning Curve

    PubMed Central

    Ferraz, Victor; Westerberg, Paul; Brand, Jefferson C.

    2013-01-01

    Whereas “anatomic” anterior cruciate ligament reconstruction may improve clinical results, the technique has introduced new technical challenges. The purpose of this technical note and video is to explore tips and tricks that improve femoral socket drilling with a retrograde reamer, bone–patellar tendon–bone graft passage, and interference screw fixation. The techniques for retrograde femoral socket drilling in an inside-out direction, bone–patellar tendon–bone graft passage, and interference screw fixation are described and demonstrated. Pitfalls, troubleshooting tips, and possible solutions are discussed. With the retrograde reamer, the femoral socket can be placed in the footprint of the anterior cruciate ligament with a longer and more vertical tunnel. By modifying the size of the patellar bone plug, graft passage is improved. With care and technique, interference screw fixation in the femoral socket over a guidewire is possible. PMID:24400187

  5. Anatomic Outside-In Anterior Cruciate Ligament Reconstruction Using a Suspension Device for Femoral Fixation

    PubMed Central

    Espejo-Baena, Alejandro; Espejo-Reina, Alejandro

    2014-01-01

    Cortical suspension is one of the most frequently used methods of femoral fixation in anterior cruciate ligament reconstruction. We present a simple technique for anterior cruciate ligament reconstruction using a suspension device for femoral fixation. The purposes of this technique are to ensure greater contact between the graft and the tunnel walls—a goal that is achieved by using the femoral fixation device with the shortest possible loop—to avoid the flip step and the need for hyperflexion, and in short, to minimize the risk of complications that can occur when using the anteromedial portal to drill the femoral tunnel. To this end, both the femoral and tibial tunnels are created in an outside-in manner and with the same guide. The graft is passed through in a craniocaudal direction, and the suspension device is fitted inside an expansion piece for a better adaptation to the femoral cortex. PMID:24904774

  6. Acute Simultaneous Ruptures of the Anterior Cruciate Ligament and Patellar Tendon

    PubMed Central

    Lee, Gwang Chul; Park, Sung-Hae

    2014-01-01

    Acute simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare injury. We present a case report of a 32-year-old male patient with ruptured ACL and ipsilateral patellar tendon rupture sustained while playing baseball. Surgery was performed on the patellar tendon and the ACL simultaneously. The clinical and radiological outcomes of the treatment were successful. We present this case with a review of the literatures. PMID:24639949

  7. Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery

    PubMed Central

    Lamo-Espinosa, J. M.; Llombart Blanco, R.; Valentí, J. R.

    2012-01-01

    We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries. PMID:22957293

  8. Re-Tensioning Technique to Cover the Graft With Remnant in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Noh, Jung Ho; Yoon, Kyoung Ho; Song, Sang Jun; Roh, Young Hak

    2014-01-01

    A number of remnant-preserving techniques to restore proprioceptive function in anterior cruciate ligament reconstruction have been described. However, they might not cover the significant amount of the graft with the synovium of the remnant in many cases. We introduce a simple technique that can cover nearly the entire graft with the synovium by re-tensioning the remnant, which might enhance synovialization of the graft and restoration of proprioception. PMID:25685673

  9. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study

    Microsoft Academic Search

    Timo Järvelä

    2007-01-01

    Anatomical observation and biomechanical studies have shown that the anterior cruciate ligament (ACL) mainly consists of two\\u000a distinct bundles, the anteromedial (AM) bundle and posterolateral (PL) bundle. Conventional single-bundle ACL reconstruction\\u000a techniques have focused on the restoration of the AM bundle while giving limited attention to the PL bundle. The purpose of\\u000a this prospective, randomized clinical study is to compare

  10. Simulated Pivot-Shift Testing with Single and Double-Bundle Anterior Cruciate Ligament Reconstructions

    Microsoft Academic Search

    Keith L. Markolf; Steven R. Jackson; David R. McAllister; David Geffen

    Background: One of the principal rationales for performing a double-bundle reconstruction of the anterior cruciate ligament is the suggestion that it may be superior to a single-bundle reconstruction in restoring a normal pivot-shift sign. The purpose of this study was to measure the abilities of single-bundle and anatomic double-bundle reconstruc- tions to restore normal knee kinematics and graft forces during

  11. Stability comparison of anterior cruciate ligament between double- and single-bundle reconstructions

    Microsoft Academic Search

    Jong Keun Seon; Sang Jin Park; Keun Bae Lee; Taek Rim Yoon; Hyoung Yeon Seo; Eun Kyoo Song

    2009-01-01

    The purpose of this study was to evaluate the intra-operative stability during double-bundle anterior cruciate ligament (ACL)\\u000a reconstructions (20 knees) using a navigation system and compare the results with those obtained from single-bundle reconstructions\\u000a (20 knees). After registering the reference points during ACL reconstruction, antero-posterior and rotational stability tests\\u000a with 30° knee flexion using a navigation system were measured before

  12. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines

    Microsoft Academic Search

    Francois Lintz; Nicolas Pujol; Philippe Boisrenoult; Kevin Bargoin; Philippe Beaufils; David Dejour

    2011-01-01

    Purpose  Anterior cruciate ligament (ACL) mucoid degeneration is a rare encounter in clinical practice, different, but often confused\\u000a with ACL mucoid cysts. Its pathophysiology remains unclear. However, recent publications have suggested that it might be underdiagnosed\\u000a or misdiagnosed, and that the adverse effects of treatment by ACL resection might be underestimated. The object of this work\\u000a was to summarize this scattered

  13. Clinically-Relevant Measures Associated with Altered Contact Forces in Patients with Anterior Cruciate Ligament Deficiency

    PubMed Central

    Gardinier, Emily S.; Manal, Kurt; Buchanan, Thomas S.; Snyder-Mackler, Lynn

    2014-01-01

    Background Knee joint contact forces are altered after anterior cruciate ligament injury during walking and may be related to clinically-relevant measures of impairments or self-reported function. The purpose of this study was to investigate the association of several clinically-relevant measures with altered knee contact forces in patients with anterior cruciate ligament injury. Methods Data for this study represent a cross-sectional observational analysis of thirty-seven (23 M, 14 F) patients with complete unilateral anterior cruciate ligament injury. Gait analysis with electromyography was used to obtain estimates of tibiofemoral joint contact force using an electromyography-driven musculoskeletal model. Multivariable linear regression was used to identify measures associated with tibiofemoral joint contact force. Findings Involved knee extensor muscle strength and patient-reported knee function on the Global Rating Scale of Perceived Function were significantly associated with peak tibiofemoral contact force for the involved limb. Patients who were stronger and who perceived higher knee function walked with greater contact forces on their involved knees. After controlling for walking speed, involved extensor strength explained 8.9% of the variance in involved peak tibiofemoral contact force and score on the Global Rating Scale explained an additional 9.4% of the variance. Interpretation Improvements in involved quadriceps strength and overall function as measured by patient self-report may be important for increasing involved limb contact forces, thereby restoring loading symmetry in these patients who demonstrate decreased involved limb loading after injury. These results highlight the potential value of studying the recovery of strength, self-reported function and joint loading symmetry in patients with anterior cruciate ligament injury. PMID:24746854

  14. Serial dilation versus extraction drilling in anterior cruciate ligament reconstruction: a biomechanical study

    Microsoft Academic Search

    O. G. Sørensen; B. W. Jakobsen; S. Kold; T. B. Hansen; K. Søballe

    2010-01-01

    The hamstring tendon graft has become increasingly popular in anterior cruciate ligament reconstruction because of low donor-site\\u000a morbidity. However, the tibial fixation is considered difficult, mainly because of low tibial mineral bone density. Therefore,\\u000a we tested whether preparation of the tibial tunnel with compaction by serial dilation provided a stronger anchorage of the\\u000a graft–fixation-device complex than does traditional extraction drilling

  15. Anterior Cruciate Ligament Revision ReconstructionResults Using a Quadriceps Tendon–Patellar Bone Autograft

    Microsoft Academic Search

    Frank R. Noyes; Sue D. Barber-Westin

    2006-01-01

    Background: The quadriceps tendon is a viable graft source for revision anterior cruciate ligament reconstruction.Purpose: To determine the functional results and graft failure rates in knees in which the patellar tendon had been previously harvested or was unavailable, expanded tunnels precluded the use of a semitendinosus-gracilis graft, or patients requested autogenous tissues instead of allografts for revision reconstruction.Study Design: Case

  16. Anterior cruciate ligament regeneration using braided biodegradable scaffolds: in vitro optimization studies

    Microsoft Academic Search

    Helen H. Lu; James A. Cooper Jr.; Sharron Manuel; Joseph W. Freeman; Mohammed A. Attawiae; Frank K. Ko; Cato T. Laurencina

    2005-01-01

    The anterior cruciate ligament (ACL) is the most commonly injured intra-articular ligament of the knee, and limitations in existing reconstruction grafts have prompted an interest in tissue engineered solutions. Previously, we reported on a tissue-engineered ACL scaffold fabricated using a novel, three-dimensional braiding technology. A critical factor in determining cellular response to such a graft is material selection. The objective

  17. Systematic review on cadaveric studies of anatomic anterior cruciate ligament reconstruction

    Microsoft Academic Search

    Carola F. van Eck; Kristian Samuelsson; Shail M. Vyas; C. Niek van Dijk; Jon Karlsson; Freddie H. Fu

    Purpose  One of the templates in the development of “anatomic” anterior cruciate ligament (ACL) reconstruction has been basic science\\u000a studies focusing on comparing various aspects of ACL reconstruction in order to optimize surgical technique. However, often\\u000a such papers lack necessary data in the methods section to ascertain the proposed surgical technique as anatomic. The goal\\u000a of this systematic review was to

  18. Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts

    Microsoft Academic Search

    J. C. L’Insalata; Brian Klatt; Freddie H. Fu; Christopher D. Harner

    1997-01-01

    Thirty patients having had anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) autograft\\u000a and thirty patients having had ACL reconstruction with hamstring (HS) autograft were enrolled. All procedures were performed\\u000a using an endoscopic technique with identical postoperative rehabilitation, such that the only variable was the type of graft\\u000a and its fixation. Lateral and 45? posteroanterior (PA) weightbearing radiographs were

  19. The Effect of Cyclic Loading on Rotated Bone-Tendon-Bone Anterior Cruciate Ligament Graft Constructs

    Microsoft Academic Search

    Eric Berkson; Gregory H. Lee; Ashwin Kumar; Nikhil Verma; Bernard R. Bach; Nadim Hallab

    2006-01-01

    Background: Single-incision anterior cruciate ligament reconstruction with a bone–patellar tendon–bone construct is commonly performed with 180° rotation of the graft. It has been hypothesized that further rotation of the graft to 540° can effectively shorten the graft to address graft length–tunnel mismatch. Initial biomechanical failure characteristics of rotated constructs have been reported, but cyclic loading of tendons has not been

  20. Femoral Press-Fit Fixation of the Hamstring Tendons for Anterior Cruciate Ligament Reconstruction

    Microsoft Academic Search

    Michael Jagodzinski; Vahid Behfar; Christof Hurschler; Knut Albrecht; Christian Krettek; Ulrich Bosch

    2004-01-01

    Background: Press-fit fixation of patellar tendon–bone anterior cruciate ligament autografts is an interesting technique because no hardware is necessary. For hamstring tendon grafts, no biomechanical data exist of a press-fit procedure.Hypothesis: Press-fit femoral fixation of hamstring tendons is mechanically equivalent to press-fit patellar tendon–bone fixation.Study Design: Controlled laboratory study.Methods: Patellar and hamstring tendons of 30 human cadavers (age, 53.8 ±

  1. Effects of Supplemental Intra-articular Lubricin and Hyaluronic Acid on the Progression of Posttraumatic Arthritis in the Anterior Cruciate Ligament-Deficient Rat Knee

    Microsoft Academic Search

    Erin Teeple; Khaled A. Elsaid; Gregory D. Jay; Ling Zhang; Gary J. Badger; Matthew Akelman; Thomas F. Bliss; Braden C. Fleming

    2011-01-01

    Background: Lubricin and hyaluronic acid lubricate articular cartilage and prevent wear. Because lubricin loss occurs after anterior cruciate ligament injury, intra-articular lubricin injections may reduce cartilage damage in the anterior cruciate ligament— deficient knee.Purpose: This study was conducted to determine if lubricin and\\/or hyaluronic acid supplementation will reduce cartilage damage in the anterior cruciate ligament—deficient knee.Study Design: Controlled laboratory study.Methods:

  2. Isometric versus tension measurements. A comparison for the reconstruction of the anterior cruciate ligament.

    PubMed

    Fleming, B; Beynnon, B D; Johnson, R J; McLeod, W D; Pope, M H

    1993-01-01

    This study was designed to compare the displacement patterns of an isometer, used to determine graft placement during reconstruction, with the actual tensions on an anterior cruciate ligament substitute. In cadaveric specimens, a Kevlar anterior cruciate ligament substitute was implanted in three separate femoral sites, each of which was subsequently fixed to two different tibial sites. The initial tension of the Kevlar substitute was set to 22 or 33 N at 20 degrees of knee flexion. The displacement patterns for each position were recorded during passive flexion-extension using the isometer. Using a custom-designed tensiometer, the tensile forces on the substitute after rigid fixation at the tibia and femur were measured. During passive flexion-extension, the maximum change in tension of the anterior cruciate ligament substitute, measured by the tensiometer, was correlated with the maximum change in displacement between attachment sites, measured by the isometer. The coefficient of determination was equal to 0.15, indicating that the isometer may not accurately predict the tensions developed in the substitute. PMID:8427374

  3. In-vitro correlation between tension and length change in an anterior cruciate ligament substitute.

    PubMed

    Good, L

    1995-06-01

    The length change and tension patterns from multiple insertion locations of an anterior cruciate ligament substitute were studied in 10 cadaver knees. Length change was measured with a spring-loaded isometer of low stiffness, and tension was measured with a piezoelectric load cell. In both instances a thin Kevlar test ligament was positioned in five different femoral and two different tibial ligament insertion locations, that were all located within the normal attachments of the anterior cruciate ligament. Differences were found regarding length changes and tension patterns from a simulated active extension between the central, posterior, and anterior femoral locations. All locations showed larger length change and tension values in extension than in flexion. The anterior femoral ligament insertion location showed length change and tension patterns with increasing values in flexion compared to the other femoral locations. The anterior tibial ligament insertion location showed smaller excursions of both length and tension, than did the central one, but the patterns of the curves were similar. A statistically significant correlation was found between length change and tension patterns throughout a 130-0 degrees range of motion. A statistically significant correlation was also found between the maximum length and tension values. No fixed relationship was found between the magnitude of the length and tension values, when different intervals of the range of motion were studied. RELEVANCE: The intraoperative employment of length change measurements of a test ligament in anterior cruciate ligament reconstruction gives information on where high tension can be expected in the range of motion of the knee, and how this can differ depending on the angle of graft fixation. The information gained can also be used to improve drill channel location. However, no predictions on the magnitude of tension can be made, mainly due to large biological variability. PMID:11415553

  4. Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability.

    PubMed

    Ng, Choong; Bialocerkowski, Andrea; Hinman, Rana

    2007-06-01

    Background? Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives? Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy? A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria? Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2?years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40?years or older, or had multidirectional instability or other concomitant shoulder pathology were excluded. Data collection and analysis? Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. Results? Eleven studies were included in the review. Two were randomised controlled trials. Evidence comparing arthroscopic and open surgical glenohumeral stabilisation was of poor to fair methodological quality. Hence, the results of primary studies should be interpreted with caution. Observed clinical heterogeneity in populations and outcomes was highlighted and should be considered when interpreting the meta-analysis. Authors also used variable definitions of recurrent instability and a variety of outcome measures, which made it difficult to synthesise results. When comparable data were pooled, there were no significant differences (P?>?0.05) between the arthroscopic and open groups with respect to recurrent instability rates, Rowe score, glenohumeral external rotation range and complication rates. Conclusions? Statistically, it appears that both surgical techniques are equally effective in managing traumatic anterior glenohumeral instability. In light of the methodological quality of the included studies, it is not possible to validate arthoscopic stabilisation to match open surgical stabilisation as the gold standard treatment. Further research using multicentred randomised controlled trials with sufficient power and instability-specific questionnaires with sound psychometric properties is recommended to build on current evidence. The choice of treatment should be based on multiple factors between the clinician and the patient. PMID:21631787

  5. Effect of Varying Hamstring Tension on Anterior Cruciate Ligament Strain During in Vitro Impulsive Knee Flexion and Compression Loading

    PubMed Central

    Withrow, Thomas J.; Huston, Laura J.; Wojtys, Edward M.; Ashton-Miller, James A.

    2008-01-01

    Background: The hamstring muscles are well positioned to limit both anterior tibial translation and anterior cruciate ligament strain during the knee flexion phase of a jump landing. We hypothesized that systematically increasing or decreasing hamstring tension during the knee flexion phase of a simulated jump landing would significantly affect peak relative strain in the anterior cruciate ligament. Methods: Ten cadaveric knees from four male and six female donors (mean age [and standard deviation] at the time of death, 60.3 ± 23.6 years) were mounted in a custom fixture to initially position the specimen in 25° of knee flexion and simulate axial impulsive loading averaging 1700 N to cause an increase in knee flexion. Quadriceps, hamstring, and gastrocnemius muscle forces were simulated with use of pretensioned linear springs, with the tension in the hamstrings arranged to be increased, held constant, decreased, at “baseline,” or absent during knee flexion. Impulsive loading applied along the tibia and femur was monitored with use of triaxial load transducers, while uniaxial load cells monitored quadriceps and medial and lateral hamstring forces. Relative strain in the anterior cruciate ligament was measured with use of a differential variable reluctance transducer, and tibiofemoral kinematics were measured optoelectronically. For each specimen, anterior cruciate ligament strains were recorded over eighty impact trials: ten preconditioning trials, ten “baseline” trials involving decreasing hamstring tension performed before and after three sets of ten trials conducted with increasing hamstring tension, constant hamstring tension, or no hamstring tension. Peak relative strains in the anterior cruciate ligament were normalized for comparison across specimens. Results: Increasing hamstring force during the knee flexion landing phase decreased the peak relative strain in the anterior cruciate ligament by >70% compared with the baseline condition (p = 0.005). Neither a constant hamstring muscle force nor the absence of a hamstring force significantly changed the peak strain in the anterior cruciate ligament relative to the baseline condition. Conclusions: Increasing hamstring muscle force during the knee flexion phase of a simulated jump landing significantly reduces the peak relative strain in the anterior cruciate ligament in vitro. Clinical Relevance: It may be possible to proactively limit peak anterior cruciate ligament strain during the knee flexion phase of jump landings by accentuating hip flexion, thereby increasing the tension in active hamstring muscles by lengthening them. PMID:18381320

  6. Quantitative evaluation of knee instability and muscle strength after anterior cruciate ligament reconstruction using patellar and quadriceps tendon

    Microsoft Academic Search

    Kazunori Yasuda; Yasumitsu Ohkoshi; Yoshie Tanabe; Kiyoshi Kaneda

    1992-01-01

    Anterior cruciate ligament reconstruction using an au tologous graft harvested from the central one-third of the patellar and quadriceps tendon was performed in 65 knees of 65 patients who were followed from 3 to 7 years. Mean anterior laxity of both knees was meas ured before and after surgery in each patient using the Styker Knee Laxity Tester. At 30°

  7. Arthroscopic Posterior Cruciate Ligament Reconstruction with Quadriceps Tendon AutograftMinimal 3 Years Follow-up

    Microsoft Academic Search

    Chih-Hwa Chen; Wen-Jer Chen; Chun-Hsiung Shih; Shih-Wei Chou

    2004-01-01

    Background: Various autografts or allografts have been used for posterior cruciate ligament (PCL) reconstruction. Quadriceps tendon-patellar bone autograft is considered a good graft choice.Hypothesis: Quadriceps tendon-patellar bone graft for PCL reconstruction can achieve a satisfactory clinical outcome after 3 years postoperatively.Study Design: Retrospective review of prospectively collected data.Methods: From 1996, the graft has been used in 32 patients. Twenty-nine patients

  8. MRI evaluation of tibial tunnel wall cortical bone formation after platelet-rich plasma applied during anterior cruciate ligament reconstruction

    PubMed Central

    Rupreht, Mitja; Vogrin, Matjaž; Hussein, Mohsen

    2013-01-01

    Background After anterior cruciate ligament (ACL) reconstruction, formation of cortical sclerotic bone encircling the femoral and tibial tunnel is a part of intratunnel graft healing. During the physiological cascades of soft tissue healing and bone growth, cellular and hormonal factors play an important role. The purpose of this study was to non-invasively but quantitatively assess the effect of intraoperatively applied platelet-rich plasma (PRP) on the formation of cortical bone encircling the tibial tunnel. Patients and methods In fifty patients, standard arthroscopic ACL reconstructions were performed. The PRP group (n = 25) received a local application of PRP while the control group (n = 25) did not receive PRP. The proximal tibial tunnel was examined by MRI in the paraxial plane where the portion of the tibial tunnel wall circumference consisting of sclerotic cortical bone was assessed with testing occurring at one, two and a half and six months after surgery. Results At one month after surgery, differences between the groups in the amount of cortical sclerotic bone encircling the tunnel were not significant (p = 0.928). At two and a half months, the sclerotic portion of the tunnel wall in the PRP group (36.2%) was significantly larger than in the control (22.5%) group (p = 0.004). At six months, the portion of sclerotic bone in the PRP group (67.1%) was also significantly larger than in the control (53.5%) group (p = 0.003). Conclusions Enhanced cortical bone formation encircling the tibial tunnel at 2.5 and 6 months after ACL graft reconstruction results from locally applied platelet-rich plasma. PMID:23801907

  9. Bone Tunnel Enlargement After Anterior Cruciate Ligament Replacement

    Microsoft Academic Search

    Mark Fahey; Peter A. Indelicato

    1994-01-01

    Radiographic increase in the size of tibial and femoral tunnels has been observed. This retrospective study compared tibial tunnel diameter in 56 autograft and 87 allograft patellar tendon bone-tendon-bone anterior cru ciate ligament replacements whose observed tunnel changes were correlated with clinical results at 1 year postoperatively. Tibial tunnel sclerotic margins were measured approximately 1 cm below the joint line.

  10. Evaluation of tibial rotational stability of single-bundle vs. anatomical double-bundle anterior cruciate ligament reconstruction during a high-demand activity — A quasi-randomized trial

    Microsoft Academic Search

    Go Misonoo; Akihiro Kanamori; Hirofumi Ida; Syumpei Miyakawa; Naoyuki Ochiai

    The purpose of this study was to compare the tibial rotational stability of anatomical double-bundle anterior cruciate ligament reconstructed knees with single-bundle anterior cruciate ligament reconstructed knees during a high-demand activity. Total of 66 subjects, (22 with double-bundle anterior cruciate ligament reconstruction, 22 with single-bundle anterior cruciate ligament reconstruction, and 22 healthy control individuals) were examined in this study. Using

  11. Effects of Sports Injury Prevention Training on the Biomechanical Risk Factors of Anterior Cruciate Ligament Injury in High School Female Basketball Players

    Microsoft Academic Search

    Bee-Oh Lim; Yong Seuk Lee; Jin Goo Kim; Keun Ok An; Jin Yoo; Young Hoo Kwon

    2009-01-01

    Background: Female athletes have a higher risk of anterior cruciate ligament injury than their male counterparts who play at similar levels in sports involving pivoting and landing.Hypothesis: The competitive female basketball players who participated in a sports injury prevention training program would show better muscle strength and flexibility and improved biomechanical properties associated with anterior cruciate ligament injury than during

  12. Knee joint accessory motion following anterior cruciate ligament allograft reconstruction: a preliminary report.

    PubMed

    Jenkins, W L; Munns, S W; Loudon, J

    1998-07-01

    Early in the postoperative period, changes in tibial translation have been noted in patient populations following anterior cruciate ligament reconstructive surgery. Deformation due to a lengthening of the ligament graft has been the most widely accepted reason for the change in tibial translation. Treatment techniques have not been proven successful in the abatement or reversal of this graft lengthening. The purpose of this study was to investigate the effect of functional bracing on tibial translation during the first year postoperatively in a group of patients with early changes in tibial translation. Three consecutive patients with early increases in KT-2000 manual maximum total drawer following bone-patellar tendon-bone allograft reconstruction were identified as subjects in the control group. Five consecutive anterior cruciate ligament bone-patellar tendon-bone allografts with early increases in KT-2000 manual maximum total drawer were identified as subjects in the treatment group. These patients were followed monthly during the first year postoperatively by manual maximum total drawer KT-2000 testing. Criteria for inclusion in the treatment and control groups included KT-2000 testing, with an increase in translation of greater than or equal to 2 mm when compared with the uninvolved knee during the first year postoperatively. The treatment group was required to wear a functional knee brace during all weight-bearing activities until KT-2000 displacement measures were stabilized for 3 consecutive months. Treatment with the functional brace resulted in a mean 2.3-mm decrease in tibial translation in the manual maximum total drawer KT-2000 when comparing the involved and uninvolved knee prebracing with posttreatment. All five subjects in the treatment group had a decrease in tibial translation. A Median Test comparing the control and treatment group's KT-2000 scores was significant at the p < .05 level. Patients who experience early increases in tibial translation with anterior cruciate ligament reconstructions may be assisted in a reduction of the displacement by the use of a functional brace. PMID:9653688

  13. Reducing the risk of noncontact anterior cruciate ligament injuries in the female athlete.

    PubMed

    Barber-Westin, Sue D; Noyes, Frank R; Smith, Stephanie Tutalo; Campbell, Thomas M

    2009-10-01

    High school and collegiate female athletes have a significantly increased risk of sustaining a noncontact anterior cruciate ligament injury compared with male athletes participating in the same sport. This review summarizes the current knowledge of the risk factors hypothesized to influence this problem, and the neuromuscular training programs designed to correct certain biomechanical problems noted in female athletes. The risk factors include a genetic predisposition for sustaining a knee ligament injury, environmental factors, anatomical indices, hormonal influences, and neuromuscular factors. The greatest amount of research in this area has studied differences between female and male athletes in movement patterns during athletic tasks; muscle strength, activation, and recruitment patterns; and knee joint stiffness under controlled, preplanned, and reactive conditions in the laboratory. Neuromuscular retraining programs have been developed in an attempt to reduce these differences. The successful programs teach athletes to control the upper body, trunk, and lower body position; lower the center of gravity by increasing hip and knee flexion during activities; and develop muscular strength and techniques to land with decreased ground reaction forces. In addition, athletes are taught to preposition the body and lower extremity prior to initial ground contact to obtain the position of greatest knee joint stability and stiffness. Two published programs have significantly reduced the incidence of noncontact anterior cruciate ligament injuries in female athletes participating in basketball, soccer, and volleyball. Other programs were ineffective, had a poor study design, or had an insufficient number of participants, which precluded a true reduction in the risk of this injury. In order to determine which risk factors for noncontact anterior cruciate ligament ruptures are significant, future investigations should include larger cohorts of athletes in multiple sports, analyze factors from all of the major risk categories, and follow athletes for at least one full athletic season. Future risk assessment studies should incorporate reactive tasks under more realistic sports conditions. PMID:20048528

  14. High articular levels of the angiogenetic factors VEGF and VEGF-receptor 2 as tissue healing biomarkers after single bundle anterior cruciate ligament reconstruction.

    PubMed

    Galliera, E; De Girolamo, L; Randelli, P; Volpi, P; Dogliotti, G; Quaglia, A; Banfi, G; Cabitza, P; Corsi, M M; Denti, M

    2011-01-01

    Various factors may account for the positive association between meniscal repair and anterior cruciate ligament reconstruction, one being the modulation of healing response of meniscal fibrochondrocytes by growth factors released with intra-articular bleeding and fibrin clot formation. Analysis of vascular endothelial growth factor (VEGF) and its receptors, VEGFR1 and VEGFR2, may be useful in the clinical assessment of bone and soft-tissue remodeling. We measured systemic and local levels of VEGF (VEGF165), VEGFR1 and VEGFR2 after either arthroscopic partial meniscectomy (APM) or single-bundle anterior cruciate ligament reconstruction (ACLR) in order to determine the local effect of bone tunnelling and notchplasty on the release of these growth factors. The study population included 40 patients: 20 consecutive patients had undergone ACLR with hamstring grafts and 20 had undergone APM. Thirty minutes after the end of the operation, knee joint fluid samples were collected via the drainage tube and at the same time venous blood samples were drawn. In both sets of samples, VEGF, VEGFR1 and VEGFR2 concentrations were determined by enzyme-linked immunosorbent assay (ELISA). No significant differences in VEGF, VEGFR1 or VEGFR2 concentrations in the venous blood were observed between the two treatment groups. In contrast, VEGF and VEGFR2 levels were significantly higher in the knee joint fluid of the ACLR group; furthermore, VEGF and VEGFR1 were significantly higher in the knee joint fluid than in the venous blood, whereas VEGFR2 was lower in the knee joint fluid than in the venous blood. Local release of VEGF and its angiogenetic receptor VEGFR2, but not the negative regulator VEGFR1, was significantly higher after ACLR than after APM, indicating a better vasculogenic potential for enhanced bone-graft and meniscus healing. These results could suggest that VEGF and VEGFRs could be considered as good biomarkers of tissue healing after knee joint surgery. PMID:21382277

  15. Popliteal Artery Pseudoaneurysm after Anterior Cruciate Ligament Re-Revision Using a Rigidfix Cross Pin

    PubMed Central

    Kim, Dong Hwi; Park, Sung-Hae

    2014-01-01

    Popliteal artery injury is a very rare complication of anterior cruciate ligament (ACL) reconstruction. The authors experienced a case of popliteal arterial pseudoaneurysm after re-revision of ACL reconstruction using Rigidfix for femoral tunnel fixation. Pseudoaneurysm was detected in knee magnetic resonance imaging, which caused pain, limit of motion, common peroneal nerve palsy, leg swelling and symptoms similar to compartment syndrome. After excision and re-anastomosis of the popliteal artery using a greater saphenous vein graft, all symptoms were resolved within 3 months except for common peroneal nerve palsy. So we report on this case with a review of the literature. PMID:24944979

  16. Can platelet-rich plasma enhance anterior cruciate ligament and meniscal repair?

    PubMed

    Hutchinson, Ian D; Rodeo, Scott A; Perrone, Gabriel S; Murray, Martha M

    2015-02-01

    The use of platelet-rich plasma (PRP) to improve clinical outcome following a soft tissue injury, regeneration, and repair has been the subject of intense investigation and discussion. This article endeavors to relate clinical and basic science strategies focused on biological augmentation of the healing response in anterior cruciate ligament (ACL) and meniscus repair and replacement using PRP. Therein, a translational feedback loop is created in the literature and targeted towards the entire multidisciplinary team. Ultimately, it is hoped that the theoretical benefits of PRP on soft-tissue interfacial healing will emerge clinically following a careful, focused characterization at the benchtop, and prospective randomized controlled clinical study. PMID:25101873

  17. Effects of twisting of the graft in anterior cruciate ligament reconstruction.

    PubMed

    Elmans, L; Wymenga, A; van Kampen, A; van der Wielen, P; Mommersteeg, T J A; Blankevoort, L

    2003-04-01

    In an in vitro study on six knees from cadavers, the effect of bone-patellar tendon-bone graft twist on anterior knee laxity was measured at different knee flexion angles. A motion and loading rig was used to prescribe the flexion angle, to restrain axial rotation, and to apply 100 N anterior force to the tibia. Roentgen stereophotogrammetric analysis was used to measure the relative anteroposterior position of the tibia and femur. The tibial bone block was cemented in a cylinder that allowed rotation in the bone tunnel. The anterior cruciate ligament was transected and reconstructed with neutral, 90 degrees, and 150 degrees internal twists and 90 degrees and 150 degrees external twists. External and internal graft twists in the reconstruction resulted in significant reductions of anterior laxity, however, at the cost of a more posterior position of the unloaded tibia relative to the femur (anteroposterior-error). The results are explained by the anterior relocation of the graft insertion by twisting the tibial bone block. The inclination angle of the graft in the anteroposterior direction flattens, which could improve the anterior laxity. A consequent side effect is the increase of posterior shift of the tibia relative to the femur. PMID:12671513

  18. The role of the RNFA in anterior cruciate ligament graft preparation.

    PubMed

    Rozakis, Melissa

    2014-11-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed orthopedic procedures in the United States. Repair of the ACL often requires the use of autografts or allografts, and the RN first assistant (RNFA) often is the team member responsible for preparing the graft. Common grafts used in ACL repair include bone-patellar tendon-bone, hamstring, Achilles tendon, quadriceps tendon, and tibialis anterior tendon. The RNFA must be competent in preparing all of these grafts and in understanding the advantages and disadvantages of using each graft, such as the reasons for graft choice, and must ensure that all graft-related supplies and equipment are available and ready for use. The ability to prepare all graft types expands treatment options, reduces surgical time, and enhances the role of the RNFA. PMID:25443120

  19. Evaluation of 3 Fixation Devices for Tibial-Sided Anterior Cruciate Ligament Graft Backup Fixation.

    PubMed

    Verioti, Christopher A; Sardelli, Matthew C; Nguyen, Tony

    2015-07-01

    We conducted a study to biomechanically evaluate 3 methods of tibial-sided fixation for anterior cruciate ligament reconstruction: fully threaded interference screw only, interference screw backed with 4.75-mm SwiveLock anchor, and fully threaded bio-interference screw backed with 4.5-mm bicortical screw (all Arthrex). Thirty skeletally mature porcine tibiae were used. The first group was prepared by graft fixation within the tibial tunnel using only an interference screw. The second and third groups included an interference screw with 2 types of secondary fixation: 4.5-mm bicortical post and SwiveLock anchor. Mechanical testing consisted of 500 cycles between 50 and 250 N at 1 Hz, followed by a pull to failure conducted at 20 mm per minute. Ultimate load-to-failure testing demonstrated the largest mean (SD) load tolerated in the post/washer group, 1148 (186) N, versus the SwiveLock group, 1007 (176) N, and the screw-only group, 778 (139) N. There was no statistical difference between the 2 backup fixation groups. Use of a SwiveLock anchor as backup fixation at the tibial side in soft-tissue anterior cruciate ligament reconstruction is a safe, effective alternative to a bicortical post and provides statistically equivalent pullout strength with unlikely requirement for future hardware removal. PMID:26161768

  20. One-stage anatomic double bundle anterior and posterior cruciate ligament reconstruction

    PubMed Central

    Acar, Baver; Ba?ar?r, Kerem; Armangil, Mehmet; Binnet, Mehmet Serdar

    2014-01-01

    Introduction: Main evidence of the heavy knee dislocations is the rupture of both Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL). There are limited sources for the treatment of both ligaments at a single stage. Materials-method: One-staged anatomic double-bundle ACL and PCL reconstruction technique has been applied to 2 cases aged 20 and 36 with traumatic knee dislocation. Lateral collateral ligament and posteriolateral corner reconstruction added to one case, and medial collateral ligament and posteriomedial corner reconstruction for the other case. Because of additional femur fractures of the both cases, ligament reconstructions have been applied after the main treatment. Anterior tibialis tendon (ATT) allograft has been used for graft for both cases because of other stabilization deficiencies of knees. It has been confirmed that femoral and tibial tunnels constructed with anatomic double-bundle technique are fitting to anatomic locations by the post-operation CT results. Post fixation screw has been used for tibia, and endobutton at femur. Results: Tracking records of patients at 8th month shows that; Lysholm score of the case aged 20 was 89, and 85 for the case aged 36. While KT-1000 values was 3.7 mm, and 4.1 mm for 15 N power; and 9.1 mm-9.6 mm with the maximum power. Conclusion: Surgical technical details of one-staged double-bundle reconstruction for ACL and PCL injuries which is gaining popularity recently has been stated. PMID:25419422

  1. The Relationship between the Angle of the Tibial Tunnel in the Coronal Plane and Loss of Flexion and Anterior Laxity after Anterior Cruciate Ligament Reconstruction

    Microsoft Academic Search

    Stephen M. Howell; Mark E. Gittins; John E. Gottlieb; Steven M. Traina; Timothy M. Zoellner

    2001-01-01

    Tension in an anterior cruciate ligament graft is greater with the knee in flexion when the angle of the tibial tunnel in the coronal plane is vertical or more perpendicular to the medial joint line of the tibia; however, the relationship of the angle of the tibial tunnel to knee function has not been studied. Greater graft tension may limit

  2. Anterior cruciate ligament reconstruction with BPTB autograft, irradiated versus non-irradiated allograft: a prospective randomized clinical study.

    PubMed

    Sun, Kang; Tian, Shaoqi; Zhang, Jihua; Xia, Changsuo; Zhang, Cailong; Yu, Tengbo

    2009-05-01

    The effect of using gamma irradiation to sterilize bone-patellar tendon-bone (BPTB) allograft on the clinical outcomes of anterior cruciate ligament (ACL) reconstruction with irradiated allograft remains controversial. Our study was aimed to analyze the clinical outcomes of arthroscopic ACL reconstruction with irradiated BPTB allograft compared with non-irradiated allograft and autograft. All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 Mrad of irradiation prior to distribution. A total of 102 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into three groups. The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months follow-up (range 24-47 months) patients were evaluated by the same observer according to objective and subjective clinical evaluations. Of these patients, 99 (autograft 33, non-irradiated allograft 34, irradiated allograft 32) were available for full evaluation. When compared the irradiated allograft group to non-irradiated allograft group or autograft group at 31 months follow-up by the Lachman test, ADT, pivot shift test and KT-2000 arthrometer testing, statistically significant differences were found. Most importantly, 87.8% of patients in the Auto group, 85.3% in the Non-Ir-Auto group and just only 31.3% in the Ir-Allo group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%) and non-irradiated allograft (8.8%). The anterior and rotational stability decreased significantly in the irradiated allograft group. According to the overall IKDC, functional, subjective evaluations and activity level testing, no statistically significant differences were found between the three groups. However, there was a trend that the functional and activity level decreased and the patients felt uncomfortable more often in the irradiated allograft group. The statistical analysis showed no significant difference between the non-irradiated allograft group and the autograft group according to the aforementioned evaluations, except that patients in the allograft group had a shorter operation time and a longer duration of postoperative fever. When comparing the postoperative duration of fever of the two allograft groups, there was also a trend that the irradiated allograft group was longer than the non-irradiated allograft group, but no significant difference was found. When the patients had a fever, the laboratory examinations of all patients were almost normal (Blood routine was normal, the values of ESR were 5 - 16 mm/h, CRP were 3 - 10 mg/l). On the basis of our study, we concluded that patients undergoing ACL reconstruction with BPTB non-irradiated allograft or autograft had similar clinical outcomes. Non-irradiated BPTB allograft is a reasonable alternative to autograft for ACL reconstruction. While the short term clinical outcomes of the ACL reconstruction with irradiated BPTB allograft were adversely affected with an increased failure rate. The less than satisfactory results led the senior authors to discontinue the use of irradiated BPTB allograft in ACL surgery and not to advocate that gamma irradiation be used as a secondary sterilizing method. Further research into alternatives to gamma irradiation is needed. PMID:19139845

  3. Comparison of Single- and Double-Bundle Anterior Cruciate Ligament Reconstructions in Restoration of Knee Kinematics and Anterior Cruciate Ligament Forces

    PubMed Central

    Seon, Jong Keun; Gadikota, Hemanth R.; Wu, Jia-Lin; Sutton, Karen; Gill, Thomas J.; Li, Guoan

    2013-01-01

    Background Anterior cruciate ligament (ACL) deficiency alters 6 degrees of freedom knee kinematics, yet only anterior translation and internal rotation have been the primary measures in previous studies. Purpose To compare the 6 degrees of freedom knee kinematics and the graft forces after single- and double-bundle ACL reconstructions under various external loading conditions. Study Design Controlled laboratory study. Methods Ten human cadaveric knees were tested with a robotic testing system under 4 conditions: intact, ACL deficient, single-bundle reconstructed with a quadrupled hamstring tendon graft, and double-bundle reconstructed with 2 looped hamstring tendon grafts. Knee kinematics and forces of the ACL or ACL graft in each knee were measured under 3 loading conditions: an anterior tibial load of 134 N, a simulated quadriceps muscle load of 400 N, and combined tibial torques (10 N·m valgus and 5 N·m internal tibial torques) at 0°, 15°, 30°, 60°, and 90° of knee flexion. Results The double-bundle reconstruction restored the anterior and medial laxities closer to the intact knee than the single-bundle reconstruction. However, the internal rotation of the tibia under the simulated quadriceps muscle load was significantly decreased when compared with the intact knee after both reconstructions, more so after double-bundle reconstruction (P < .05). The entire graft force of the double-bundle reconstruction was more similar to that of the intact ACL than that of the single-bundle reconstruction. However, the posterolateral bundle graft in the double-bundle reconstructed knee was overloaded as compared with the intact posterolateral bundle. Conclusion The double-bundle reconstruction can better restore the normal anterior-posterior and medial-lateral laxities than the single-bundle reconstruction can, but an overloading of the posterolateral bundle graft can occur in a double-bundle reconstructed knee. Clinical relevance Both single-bundle and double-bundle techniques cannot restore the rotational laxities and the ACL force distributions of the intact knee. PMID:20392968

  4. The effects of dual-tasking on postural control in people with unilateral anterior cruciate ligament injury

    Microsoft Academic Search

    Hossein Negahban; Mohammad Reza Hadian; Mahyar Salavati; Masood Mazaheri; Saeed Talebian; Amir Homayoun Jafari; Mohamad Parnianpour

    2009-01-01

    Several studies have investigated postural control in anterior cruciate ligament (ACL) deficient patients; yet the contribution of cognitive processing (attention) in the postural control of these patients is still unclear. A dual-task design was used to determine the effects of a concurrent digit span memory task on standing balance in a group of ACL patients (n=27) compared with a group

  5. Investigating isolated neuromuscular control contributions to non-contact anterior cruciate ligament injury risk via computer simulation methods

    Microsoft Academic Search

    Scott G. McLean; Xuemei Huang; Antonie J. van den Bogert

    2008-01-01

    BackgroundDespite the ongoing evolution of anterior cruciate ligament injury prevention methods, injury rates and the associated sex-disparity remain. Strategies capable of successfully countering key control parameters existent within the injury mechanism thus remain elusive. Forward dynamics model simulations afford an expedited means to study realistic injury causing scenarios, while controlling all facets of the movement control strategy. Utilizing these methods,

  6. A stochastic biomechanical model for risk and risk factors of non-contact anterior cruciate ligament injuries

    Microsoft Academic Search

    Cheng-Feng Lin; Michael Gross; Chuanshu Ji; Darin Padua; Paul Weinhold; William E. Garrett; Bing Yu

    2009-01-01

    Gender has been identified as a risk factor for non-contact anterior cruciate ligament (ACL) injuries. Although some possible biomechanical risk factors underlying the gender differences in the risk for non-contact ACL injuries have been identified, they have not been quantitatively confirmed yet because of the descriptive nature of the traditional epidemiological methods. The purpose of this study was to validate

  7. Electromechanical Delay of the Knee Flexor Muscles Is Impaired After Harvesting Hamstring Tendons for Anterior Cruciate Ligament Reconstruction

    Microsoft Academic Search

    Stavros Ristanis; Elias Tsepis; Dimitrios Giotis; Nicholas Stergiou; Guiliano Cerulli; Anastasios D. Georgoulis

    2009-01-01

    Background: Changes in electromechanical delay during muscle activation are expected when there are substantial alterations in the structural properties of the musculotendinous tissue. In anterior cruciate ligament reconstruction, specific tendons are being harvested for grafts. Thus, there is an associated scar tissue development at the tendon that may affect the corresponding electromechanical delay.Purpose: This study was conducted to investigate whether

  8. Change in knee kinematics during gait after eccentric isokinetic training for quadriceps in subjects submitted to anterior cruciate ligament reconstruction

    Microsoft Academic Search

    H. J. C. G. Coury; J. S. Brasileiro; T. F. Salvini; P. R. Poletto; L. Carnaz; G.-A. Hansson

    2006-01-01

    Knee kinematics after anterior cruciate ligament (ACL) reconstruction is of interest in studies evaluating the effect of training programs. Many studies have addressed knee flexion\\/extension but not valgus\\/varus movements. Considering that joint stability is a major concern in ACL reconstruction surgery, movements occurring in the frontal plane of the knee also deserve attention. Knee extensor torque was analyzed by an

  9. The migration of cells from the ruptured human anterior cruciate ligament into collagen-glycosaminoglycan regeneration templates in vitro

    Microsoft Academic Search

    M Meaney Murray; M Spector

    2001-01-01

    Guided tissue regeneration of the ruptured anterior cruciate ligament (ACL) offers the potential benefits of retaining the complex footprints of the ACL and the proprioceptive nerve fibers of the tissue. For this approach to be successful, ACL cells must retain the ability to migrate into an adjacent regeneration template, or scaffold, after ligament rupture. Ruptured ACLs were obtained from the

  10. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury

    Microsoft Academic Search

    L. S. Lohmander; M. Englund; H. Roos

    2004-01-01

    Objective. To determine the prevalence of radio- graphic knee osteoarthritis (OA) as well as knee-related symptoms and functional limitations in female soccer players 12 years after an anterior cruciate ligament (ACL) injury. Methods. Female soccer players who sustained an ACL injury 12 years earlier were examined with stan- dardized weight-bearing knee radiography and 2 self- administered patient questionnaires, the Knee

  11. Biomechanical Comparison of Anatomic Double-Bundle, Anatomic Single-Bundle, and Nonanatomic Single-Bundle Anterior Cruciate Ligament Reconstructions

    Microsoft Academic Search

    Eiji Kondo; Azhar M. Merican; Kazunori Yasuda; Andrew A. Amis

    2011-01-01

    Background: Although both anatomic double-bundle and single-bundle anterior cruciate ligament reconstruction procedures are in use, it remains controversial whether the anatomic double-bundle procedure is biomechanically superior.Hypothesis: The anatomic double-bundle procedure would be better than both laterally placed anatomic and nonanatomic trans-tibial single-bundle procedures at restoring to normal the tibial anterior translation, internal rotation, and pivot-shift instability. It was also hypothesized

  12. Biomechanical comparison of anatomic double-bundle, anatomic single-bundle, and nonanatomic single-bundle anterior cruciate ligament reconstructions

    Microsoft Academic Search

    E. Kondo; A. M. Merican; K. Yasuda; A. A. Amis

    2011-01-01

    BACKGROUND: Although both anatomic double-bundle and single-bundle anterior cruciate ligament reconstruction procedures are in use, it remains controversial whether the anatomic double-bundle procedure is biomechanically superior. HYPOTHESIS: The anatomic double-bundle procedure would be better than both laterally placed anatomic and nonanatomic transtibial single-bundle procedures at restoring to normal the tibial anterior translation, internal rotation, and pivot-shift instability. It was also

  13. Prospective Comparative Study of Anterior Cruciate Ligament Reconstruction Using the Double-Bundle and Single-Bundle Techniques

    Microsoft Academic Search

    Eun Kyoo Song; Luke S. Oh; Thomas J. Gill; Guoan Li; Hemanth R. Gadikota; Jong Keun Seon

    Results: Intraoperative anterior and rotational stabilities after anterior cruciate ligament reconstruction in the double-bundle group were significantly better than those in single-bundle group (P = .020 and P < .001, respectively). Nineteen patients (95%) in each group were available at a minimum 2-year follow-up. Clinical outcomes including Lysholm knee and Tegner activity scores were similar in the 2 groups at

  14. Surgical technique, using skin, for repair of simultaneously ruptured anterior cruciate and medial collateral ligaments of the canine femorotibial articulation 

    E-print Network

    Chastain, Jamie Neal

    1959-01-01

    LIBRARY A A M JLLESE OF TEXAS SURGICAL TECHNIQUE, USING SKIN, FOB REPAIR SIMULTANE!XJSLY RUPITJRED ANTERIOR CRUCIATE AND MEDIAL COLLATERAL LIGAMENTS OF T!JE CANINE FEMOROfIDIAL ARTICULATION A Theeie Subnitted to the Graduate School of Tbe... OF SINULTANE(I]SLY RUFfURED ANTERI(KJ CRUCIATE AND MEDIAL COLIATERAL LIGANE?TS Cff TIJE CANINE FENOROTIBIAL ARTICULATION A Thesis JaJsie Neal Chastain Approved as to style and oontent byJ (Chairnsn of Cosssit tee (He of DepartsJent or Student Advisor...

  15. Reconstruction of the anterior cruciate ligament using allogeneic tendon. Long-term followup.

    PubMed

    Shino, K; Inoue, M; Horibe, S; Hamada, M; Ono, K

    1990-01-01

    Eighty-four patients who underwent ACL reconstruction with fresh-frozen allogeneic tendon were reviewed and evaluated with subjective and functional rating scales, physical examinations, instrumented anterior drawer tests, isokinetic testing, and arthroscopy. The average followup was 57 months (range, 36 to 90 months) and the average age at operation was 22 years (range, 16 to 37 years). The subjective and functional results were rated as excellent in 48 patients (57%), good in 31 (37%), and fair in 2 (2%). Three patients (3%) experienced a retear of the ACL. Physical examinations and instrumented anterior drawer tests showed that satisfactory anterior stability was restored in 88% of the patients. Isokinetic evaluations demonstrated that the extension torque of the involved knee recovered to a slightly lower level than that of the controls, although the flexion torque recovered to a level equivalent to that of the controls. Arthroscopic evaluations revealed that the allografts were elaborately remodeled, viable, and taut. There was no sign of immunologic rejection at any time postoperatively. Additional extraarticular procedures, consisting of both pes anserinus transfer on the medial side and iliotibial band reinforcement on the lateral side, had no effect on the results. PMID:2252084

  16. Cartilage Pressure Distributions Provide a Footprint to Define Female Anterior Cruciate Ligament Injury Mechanisms

    PubMed Central

    Quatman, Carmen E.; Kiapour, Ali; Myer, Gregory D.; Ford, Kevin R.; Demetropoulos, Constantine K.; Goel, Vijay K.; Hewett, Timothy E.

    2012-01-01

    Background Bone bruises located on the lateral femoral condyle and posterolateral tibia are commonly associated with anterior cruciate ligament (ACL) injuries and may contribute to the high risk for knee osteoarthritis after ACL injury. The resultant footprint (location) of a bone bruise after ACL injury provides evidence of the inciting injury mechanism. Purpose/Hypothesis (1) To analyze tibial and femoral articular cartilage pressure distributions during normal landing and injury simulations, and (2) to evaluate ACL strains for conditions that lead to articular cartilage pressure distributions similar to bone bruise patterns associated with ACL injury. The hypothesis was that combined knee abduction and anterior tibial translation injury simulations would demonstrate peak articular cartilage pressure distributions in the lateral femoral condyle and posterolateral tibia. The corollary hypothesis was that combined knee abduction and anterior tibial translation injury conditions would result in the highest ACL strains. Study Design Descriptive laboratory study. Methods Prospective biomechanical data from athletes who subsequently suffered ACL injuries after testing (n = 9) and uninjured teammates (n = 390) were used as baseline input data for finite element model comparisons. Results Peak articular pressures that occurred on the posterolateral tibia and lateral femoral condyle were demonstrated for injury conditions that had a baseline knee abduction angle of 5°. Combined planar injury conditions of abduction/anterior tibial translation, anterior tibial translation/internal tibial rotation, or anterior tibial translation/external tibial rotation or isolated anterior tibial translation, external tibial rotation, or internal tibial rotation resulted in peak pressures in the posterolateral tibia and lateral femur. The highest ACL strains occurred during the combined abduction/anterior tibial translation condition in the group that had a baseline knee abduction angle of 5°. Conclusion The results of this study support a valgus collapse as the major ACL injury mechanism that results from tibial abduction rotations combined with anterior tibial translation or external or internal tibial rotations. Clinical Relevance Reduction of large multiplanar knee motions that include abduction, anterior translation, and internal/external tibial motions may reduce the risk for ACL injuries and associated bone bruises. In particular, prevention of an abduction knee posture during initial contact of the foot with the ground may help prevent ACL injury. PMID:21487121

  17. Lessons learnt from an atypical mycobacterium infection post-anterior cruciate ligament reconstruction.

    PubMed

    Ng, Stacy W L; Yee Han, Dave Lee

    2015-03-01

    Infections following anterior cruciate ligament reconstruction are rare, with no previous reports citing Mycobacterium abscessus as the culprit pathogen. A 22-year-old man presented twice over three years with a painful discharging sinus over his right tibia tunnel site necessitating repeated arthroscopy and washout, months of antibiotic therapy, and ultimately culminating in the removal of the implants. In both instances, M. abscessus was present in the wound cultures, along with a coinfection of Staphyloccocus aureus during the second presentation. Though rare, M. abscessus is an important pathogen to consider in postoperative wounds presenting with chronic discharging sinuses, even in healthy non-immunocompromised patients. This case illustrates how the organism can cause an indolent infection, and how the removal of implants can be necessary to prevent the persistence of infection. Coinfection with a second organism is not uncommon and necessitates a timely change in treatment regime as well. PMID:25729530

  18. Anterior cruciate ligament injury: identification of risk factors and prevention strategies.

    PubMed

    Acevedo, Rafael J; Rivera-Vega, Alexandra; Miranda, Gerardo; Micheo, William

    2014-01-01

    Injury to the anterior cruciate ligament (ACL) is common and affects young individuals, particularly girls, who are active in sports that involve jumping, pivoting, as well as change of direction. ACL injury is associated with potential long-term complications including reduction in activity levels and osteoarthritis. Multiple intrinsic and extrinsic risk factors have been identified, which include anatomic variations, neuromuscular deficits, biomechanical abnormalities, playing environment, and hormonal status. Multicomponent prevention programs have been shown to be effective in reducing the incidence of this injury in both girls and boys. Programs should include a combination of strengthening, stretching, aerobic conditioning, plyometrics, proprioceptive and balance training, as well as education and feedback regarding body mechanics and proper landing pattern. Preventive programs should be implemented at least 6 wk prior to competition, followed by a maintenance program during the season. PMID:24819011

  19. Regeneration of the anterior cruciate ligament: Current strategies in tissue engineering

    PubMed Central

    Nau, Thomas; Teuschl, Andreas

    2015-01-01

    Recent advancements in the field of musculoskeletal tissue engineering have raised an increasing interest in the regeneration of the anterior cruciate ligament (ACL). It is the aim of this article to review the current research efforts and highlight promising tissue engineering strategies. The four main components of tissue engineering also apply in several ACL regeneration research efforts. Scaffolds from biological materials, biodegradable polymers and composite materials are used. The main cell sources are mesenchymal stem cells and ACL fibroblasts. In addition, growth factors and mechanical stimuli are applied. So far, the regenerated ACL constructs have been tested in a few animal studies and the results are encouraging. The different strategies, from in vitro ACL regeneration in bioreactor systems to bio-enhanced repair and regeneration, are under constant development. We expect considerable progress in the near future that will result in a realistic option for ACL surgery soon. PMID:25621217

  20. A dynamic test of lower extremity function following anterior cruciate ligament reconstruction and rehabilitation.

    PubMed

    Juris, P M; Phillips, E M; Dalpe, C; Edwards, C; Gotlin, R S; Kane, D J

    1997-10-01

    It is essential to assess the functional status of patients with surgically reconstructed and rehabilitated anterior cruciate ligaments prior to discharge. This study established a testing paradigm for functional force production and absorption. Data were obtained from 100 healthy subjects for maximal hops, controlled leaps, and hopping and leaping symmetry. Only 10% of symptomatic patients met maximal hopping criteria, while 15% achieved controlled leaping norms. Ninety-five percent of these patients failed to reach both hopping and leaping symmetry norms. Asymptomatic patients were 63% successful in meeting hopping criteria, and 57% were successful in meeting leaping criteria. Hop symmetry and leap symmetry were achieved at rates of 70% and 60%, respectively. The performance of both groups fell significantly below that of normal subjects (p < .05). Data suggest that this protocol does accurately assess functional and dysfunctional knees, and that force absorption may be more critical than force production in the determination of functional capacity. PMID:9310909

  1. State-of-the-art anterior cruciate ligament tears: A primer for primary care physicians.

    PubMed

    Salzler, Matt; Nwachukwu, Benedict U; Rosas, Samuel; Nguyen, Chau; Law, Tsun Yee; Eberle, Thomas; McCormick, Frank

    2015-05-01

    The purpose of this article is to provide primary care physicians and other members of the medical community with an updated, general review on the subject of anterior cruciate ligament (ACL) tears. We aim to enhance awareness of these injuries and to prepare those practicing in the primary care setting to address these injuries. Because ACL injuries are quite common, it is very likely that a primary care physician will encounter these injuries and need to address them acutely. The current literature is replete with new concepts and controversies regarding ACL injuries, and this article provides a concise review for our target audience in regard to the care of a patient with an ACL injury. This article is composed of an overview with current epidemiologic data, basic anatomy and physiology, clinical presentation, physical examination findings, imaging modalities, and treatment options. After reading this short article, a medical care provider should understand ACL injuries and their appropriate management. PMID:25703144

  2. A review of selected noncontact anterior cruciate ligament injuries in the National Football League.

    PubMed

    Scranton, P E; Whitesel, J P; Powell, J W; Dormer, S G; Heidt, R S; Losse, G; Cawley, P W

    1997-12-01

    During five football seasons, from 1989 through 1993, 61 surgically proven, noncontact, anterior cruciate ligament injuries, were identified from among 22 National Football League teams. The variables of surface, shoe type, playing conditions, and whether or not the shoe was spatted were identified for each reported injury. Forty noncontact injuries occurred in conventional cleated shoes on natural grass, and 21 occurred on an artificial surface. Almost half of all injuries (47.5%) occurred during game-day exposures despite the fact that the practice versus game-day exposure rate was 5:1. Of these injuries, 95.2% (N = 58) occurred on a dry field. The factors of cleat and shoe type, type of surface (natural versus artificial), surface conditions (wet/dry), and the effect of "spatting" a shoe are presented. The significance of these factors and their likelihood to be associated with injury is analyzed by use of a statistical tool, the incidence density ratio. PMID:9429878

  3. Factors affecting return to play after anterior cruciate ligament reconstruction: a review of the current literature.

    PubMed

    Bauer, Matthew; Feeley, Brian T; Wawrzyniak, John R; Pinkowsky, Gregory; Gallo, Robert A

    2014-11-01

    Anterior cruciate ligament reconstruction has been reported to produce normal or near-normal knee results in > 90% of patients. A recent meta-analysis suggested that, despite normal or near-normal knees, many athletes do not return to sports. Rates and timing of return to competitive athletics are quite variable depending on the graft type, the age of the patient, the sport, and the level of play. Even when athletes do return to play, often they do not return to their previous level. Graft failure, subjective physical factors, and psychological factors, including fear of reinjury and lack of motivation, appear to play a large role in patients' ability to return to sporting activities. PMID:25419890

  4. Correlation between Femoral Guidewire Position and Tunnel Communication in Double Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Lee, Sang Hyuk; Choi, Jun Young; Kim, Dong Hee; Kang, Bun Jung; Nam, Dae Cheol; Yoon, Hong Kwon

    2014-01-01

    Purpose The object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions required to prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees. Materials and Methods The centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured. Results In four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel. Conclusion The technique for double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness. PMID:25323896

  5. Change in posture control after recent knee anterior cruciate ligament reconstruction?

    PubMed

    Dauty, Marc; Collon, Sylvie; Dubois, Charles

    2010-05-01

    The aim of this study was to compare statical postures of a knee anterior cruciate ligament reconstruction (ACLR) population with a healthy control population. Thirty-five patients (age 25.5 +/- 5.8 years) were compared at 15 days after an anterior cruciate ligament reconstruction with 35 healthy, age and sex-matched subjects. Bilateral and unilateral postures were studied according to various stances, knee extension and 20 degrees knee flexion with opened and closed eyes, using a stabilometric platform. A comparison with the non-ACLR limb and the healthy limbs of the control population was carried out. The ACLR subjects present with the following: (i) a significant change in two-legged stance, i.e. distances covered by the centre of pressure projection are significantly increased; (ii) a postural alteration during the ACLR one-legged stance with knee extension and opened eyes in comparison with the non-ACLR limb; (iii) an incapacity for certain ACLR subjects to perform one-legged stance on the non-ACLR limb when there is no visual compensation. Only 11.4% (95% CI: 0.9-21.9%) and 42.8% (95% CI: 26.3-59.3%) of ACLR subjects are capable of maintaining correctly a one-legged stance posture with closed eyes on both sides (knee extension and flexion, respectively). The identification of the ACLR knee limb is possible from the one-legged stance postural test in knee extension and opened eyes condition. Because of a change in two-legged balance and of the incapacity for certain ACLR subjects to maintain one-legged stance with closed eyes, a central origin explaining the abnormalities of postural control is suggested. PMID:20345971

  6. Assessment and Evaluation of Predisposing Factors to Anterior Cruciate Ligament Injury

    PubMed Central

    Bonci, Christine M.

    1999-01-01

    Objective: Injury to the knee, specifically the anterior cruciate ligament (ACL), constitutes one of the most serious disabling injuries in sports. Women are reportedly at an increased risk. Prevention depends on identifying possible risk factors that may contribute to an athlete's susceptibility to injury. The major objective of this article is to lay the groundwork for standardization of a screening protocol (1) by providing rationale for the use of selected variables that might be good predictors of noncontact ACL injury and (2) by describing appropriate measurement indices to further investigate their predictive power. Standardization of a screening protocol is the first step in developing both a reliable and valid assessment tool with predictive value for injury and outcome strategies to meet the special needs of patients. Data Sources: MEDLINE was searched from 1980 to 1998 using the terms “anterior cruciate ligament injury,” “knee joint stability,” “postural malalignments” “structural abnormalities,” “static structural measures,” “musculoskeletal strength imbalances,” “isokinetic testing,” and “functional performance tests.” Data Synthesis: Many different factors, both extrinsic and intrinsic, have been investigated in the search for predictors of noncontact ACL injuries. Based on a literature review, 3 factors in particular have garnered considerable attention from clinicians and researchers: static postural malalignments with special reference to excessive foot pronation, knee recurvatum, and external tibial torsion; lower extremity musculoskeletal strength; and neuromuscular control considerations. However, much of the information known about the predictive value of these variables is inconclusive and conflicting at best, prompting the need for additional investigation. Conclusions/Recommendations: Screening evaluations are routinely employed as part of clinical work-ups when athletes are healthy and in top form. The data collected have the potential to provide clinicians with important baseline information for maximizing structural and functional outcome strategies when deficiencies in test results are observed in subgroups of athletes matched for age, sex, and training or performance expectations. PMID:16558559

  7. Resorbable screws versus pins for optimal transplant fixation (SPOT) in anterior cruciate ligament replacement with autologous hamstring grafts: rationale and design of a randomized, controlled, patient and investigator blinded trial [ISRCTN17384369

    PubMed Central

    Stengel, Dirk; Matthes, Gerrit; Seifert, Julia; Tober, Volker; Mutze, Sven; Rademacher, Grit; Ekkernkamp, Axel; Bauwens, Kai; Wich, Michael; Casper, Dirk

    2005-01-01

    Background Ruptures of the anterior cruciate ligament (ACL) are common injuries to the knee joint. Arthroscopic ACL replacement by autologous tendon grafts has established itself as a standard of care. Data from both experimental and observational studies suggest that surgical reconstruction does not fully restore knee stability. Persisting anterior laxity may lead to recurrent episodes of giving-way and cartilage damage. This might at least in part depend on the method of graft fixation in the bony tunnels. Whereas resorbable screws are easy to handle, pins may better preserve graft tension. The objective of this study is to determine whether pinning of ACL grafts reduces residual anterior laxity six months after surgery as compared to screw fixation. Design/ Methods SPOT is a randomised, controlled, patient and investigator blinded trial conducted at a single academic institution. Eligible patients are scheduled to arthroscopic ACL repair with triple-stranded hamstring grafts, conducted by a single, experienced surgeon. Intraoperatively, subjects willing to engage in this study will be randomised to transplant tethering with either resorbable screws or resorbable pins. No other changes apply to locally established treatment protocols. Patients and clinical investigators will remain blinded to the assigned fixation method until the six-month follow-up examination. The primary outcome is the side-to-side (repaired to healthy knee) difference in anterior translation as measured by the KT-1000 arthrometer at a defined load (89 N) six months after surgery. A sample size of 54 patients will yield a power of 80% to detect a difference of 1.0 mm ± standard deviation 1.2 mm at a two-sided alpha of 5% with a t-test for independent samples. Secondary outcomes (generic and disease-specific measures of quality of life, magnetic resonance imaging morphology of transplants and devices) will be handled in an exploratory fashion. Conclusion SPOT aims at showing a reduction in anterior knee laxity after fixing ACL grafts by pins compared to screws. PMID:15723704

  8. Open Bankart Repair Versus Arthroscopic Repair with Transglenoid Sutures or Bioabsorbable Tacks for Recurrent Anterior Instability of the ShoulderA Meta-analysis

    Microsoft Academic Search

    Kevin B. Freedman; Adam P. Smith; Anthony A. Romeo; Brian J. Cole; Bernard R. Bach

    2004-01-01

    Background: In published comparative studies, it remains unknown if arthroscopic techniques for performing Bankart repair for anterior shoulder instability equal the success of open repair.Hypothesis: The current literature supports a lower rate of recurrent instability after open Bankart repair compared to arthro-scopic repair with bioabsorbable tacks or transglenoid sutures.Study Design: Meta-analysis.Methods: A Medline search identified all randomized controlled trials or

  9. Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts and Bioabsorbable Interference Screw FixationProspective, Randomized, Clinical Study With 2Year Results

    Microsoft Academic Search

    Timo Järvelä; Anna-Stina Moisala; Raine Sihvonen; Sally Järvelä; Pekka Kannus; Markku Järvinen

    2008-01-01

    Background: Conventional anterior cruciate ligament reconstruction techniques have focused on restoration of the anteromedial bundle only, which, however, may be insufficient in restoring the rotational stability of the knee.Hypothesis: Rotational stability of the knee is better when using a double-bundle technique instead of a single-bundle technique for anterior cruciate ligament reconstruction.Study Design: Randomized controlled clinical trial; Level of evidence, 1.Methods:

  10. Knee Stability and Graft Function After Anterior Cruciate Ligament ReconstructionA Comparison of a Lateral and an Anatomical Femoral Tunnel Placement

    Microsoft Academic Search

    Yuji Yamamoto; Wei-Hsiu HsuMD; Savio L. Y. Woo; Andrew H. Van Scyoc; Yoshiyuki Takakura; Richard E. Debski

    2004-01-01

    Background: Locations of femoral tunnels for anterior cruciate ligament replacement grafts remain a subject of debate.Hypothesis: A lateral femoral tunnel placed at the insertion of the posterolateral bundle of the anterior cruciate ligament can restore knee function comparably to anatomical femoral tunnel placement.Study Design: Controlled laboratory study.Methods: Ten cadaveric knees were subjected to the following external loading conditions: (1) a

  11. A Surgical Trick for Adjusting an Inaccurate Guide Pin to the Center of the Tibial Footprint in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Apivatgaroon, Adinun; Chernchujit, Bancha

    2014-01-01

    Anatomic positioning of the graft in anatomic anterior cruciate ligament reconstruction is the key to improved knee stability, restoration of normal knee kinematics, and the prevention of long-term joint degeneration. We have developed a technique for adjusting inaccurate drill guide placement to the center of the tibial footprint in anatomic single-bundle anterior cruciate ligament reconstruction. This technique can solve the inaccurate drill guide placement problems that may be encountered during this surgical procedure. PMID:24904776

  12. Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: a systematic review and meta-analysis.

    PubMed

    Bates, Nathaniel A; Myer, Gregory D; Shearn, Jason T; Hewett, Timothy E

    2015-01-01

    Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined. PMID:25547070

  13. Results of Transphyseal Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Autograft in Tanner Stage 3 or 4 Adolescents with Clearly Open Growth Plates

    Microsoft Academic Search

    K. Donald Shelbourne; Tinker Gray; Bryan V. Wiley

    2004-01-01

    Background: Drilling across the physes for intra-articular anterior cruciate ligament reconstruction is considered risky for skeletally immature patients.Hypothesis: Skeletally immature patients with clearly open growth plates can safely undergo intra-articular anterior cruciate ligament reconstruction with patellar tendon autograft without suffering growth plate disturbance.Study Design: Retrospective review of prospectively collected data.Methods: Surgery involved drilling tunnels through the tibial and femoral physes,

  14. Anatomical reconstruction of the anterior talofibular and calcaneofibular ligaments with an all-arthroscopic surgical technique.

    PubMed

    Guillo, S; Cordier, G; Sonnery-Cottet, B; Bauer, T

    2014-12-01

    Arthroscopy is becoming an essential tool for the treatment of chronic lateral ankle instability. It allows the surgeon to determine which ligaments are injured and choose the most appropriate surgical repair technique, and also to assess and treat any associated injuries. Several arthroscopic techniques for lateral ankle ligament repair have recently been developed. As a consequence, it may be possible to carry out complete lateral ligament reconstruction with an all-arthroscopic procedure. Such an arthroscopic lateral ankle ligament reconstruction technique is described in this article. PMID:25454336

  15. Double-bundle versus single-bundle anterior cruciate ligament reconstructions: a prospective, randomized study with 2-year follow-up.

    PubMed

    Zhang, Zhenxiang; Gu, Beibei; Zhu, Wei; Zhu, Lixian

    2014-05-01

    This prospective, randomized study was conducted to compare the short-term results of arthroscopic double-bundle with single-bundle anterior cruciate ligament (ACL) reconstruction. One hundred and eight patients with a symptomatic ACL rupture were randomized to either double-bundle (Group DB) or single-bundle (Group SB) ACL reconstruction. Follow-up was conducted at 6, 12, 18 and 24 months postoperatively. At the 24-month follow-up, 94 of the 108 patients (87%) were available for evaluation. The rotational stability, as evaluated by pivot shift test, was significantly superior in the Group DB to that in the Group SB. No significant difference with regard to ACL revisions, total flexion work, mean peak flexion torque and extension work between the groups was detected. There was no significant difference between the groups in terms of the Tegner activity score, the knee injury and osteoarthritis outcome score, the Lysholm functional score, anterior knee pain or mobility, subjective knee function. In addition, no significant difference in laxity on the Lachman test or the KT-1000 maximum manual force test was investigated. All the results were significantly more satisfactory at each follow-up period than preoperatively, in both groups. Both SB- and DB-ACL reconstruction resulted in satisfactory subjective outcome and objective stability. Both these techniques can therefore be considered as suitable alternatives for ACL reconstruction. Moreover, as it seems to be according to the pivot shift test, the risk for the development of degenerative changes of the knee joint in a long run could be smaller in the Group DB. PMID:23595769

  16. Anatomical Single-bundle Anterior Cruciate Ligament Reconstruction Using a Freehand Transtibial Technique

    PubMed Central

    Nha, Kyung-Wook; Han, Jae-Hwi; Kwon, Jae-Ho; Kang, Kyung-Woon; Park, Hyung-Joon

    2015-01-01

    Purpose In anatomical single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, the traditional transtibial approach can limit anatomical placement of the femoral tunnel. Surgical Technique We present a novel three-point freehand technique that allows for anatomic SB ACL reconstruction with the transtibial technique. Materials and Methods Between January 2012 and December 2012, 55 ACL reconstructions were performed using the three-point freehand technique. All the patients were followed for a minimum of 12 months post-operatively. Clinical evaluation was done using the Lysholm score and International Knee Documentation Committee (IKDC) grade. All patients were analyzed by 3-dimensional computed tomography (3D CT) at 1 week after surgery. Results The mean Lysholm score improved from 68.2±12.7 points preoperatively to 89.2±8.2 points at final follow-up. At final follow-up, the IKDC grade was normal in 42 patients and nearly normal in 13 patients. None of the patients had a positive pivot shift test, anterior drawer test and Lachman test at final follow-up. The anatomical position of the femoral tunnel was confirmed on 3D CT scans. Conclusions The three-point freehand technique for SB transtibial ACL reconstruction is a simple, anatomic technique showing good clinical results.

  17. [Plastic surgery of the anterior cruciate ligament: experimental study of intra-articular aramid fibers in dogs].

    PubMed

    Passuti, N; Daculsi, G; Gouin, F; Martin, S; Vigneron, M

    1989-01-01

    The authors explored the possibility of replacing an anterior cruciate ligament with an aramid fiber (Kevlar) implant. This study was performed in intra-articular site in 9 dogs and the average implantation period was 5 months. Studies were carried out by macroscopic, photon microscopy, and electron microscopy examination of the samples obtained at the time the animals were sacrificed. Clinical and radiographic studies of the knees were performed in order to assess functional consequences. Overall, the results showed a partial or complete rupture of 10 neoligaments out of the 17 studied ligaments; on the other hand, osseous anchorage and reintegration in the intra-articular zone appeared satisfactory. Kevlar fiber only partially meets the performance specifications for an artificial ligament intended to serve as an anterior cruciate ligament substitute. Some positive results have encouraged the authors to carry on further this experimental study. PMID:2595049

  18. Rotational and translational laxity after computer-navigated single- and double-bundle anterior cruciate ligament reconstruction

    Microsoft Academic Search

    M. Hofbauer; P. Valentin; R. Kdolsky; R. C. Ostermann; A. Graf; M. Figl; S. Aldrian

    2010-01-01

    Based on biomechanical cadaver studies, anatomic double-bundle reconstruction of the anterior cruciate ligament (ACL) was\\u000a introduced to achieve better stability in the knee, particularly in respect of rotatory loads. Previously, the success of\\u000a ACL reconstruction was believed to be mainly dependent on correct positioning of the graft, irrespective of the number of\\u000a reconstructed bundles for which computer-assisted surgery was developed

  19. Comparison of Rotatory Stability After Anterior Cruciate Ligament Reconstruction Between Single-Bundle and Double-Bundle Techniques

    Microsoft Academic Search

    Toshiaki Izawa; Ken Okazaki; Yasutaka Tashiro; Hirokazu Matsubara; Hiromasa Miura; Shuichi Matsuda; Makoto Hashizume; Yukihide Iwamoto

    2011-01-01

    Background: Controversy persists as to whether double-bundle reconstruction of the anterior cruciate ligament (ACL) has any clinical advantage over single-bundle reconstruction. Several studies have used subjective and nonquantitative manual tests to evaluate the rotatory stability of the knee. The authors have developed a method to quantitate the rotatory stability of the ACL-deficient knee using open magnetic resonance imaging (MRI).Hypothesis: Anatomic

  20. Two-Bundle Reconstruction of the Anterior Cruciate Ligament Using Semitendinosus Tendon With Endobuttons: Operative Technique and Preliminary Results

    Microsoft Academic Search

    Takeshi Muneta; Ichiro Sekiya; Kazuyoshi Yagishita; Takashi Ogiuchi; Haruyasu Yamamoto; Kenichi Shinomiya

    1999-01-01

    Summary: We carried out two-bundle reconstruction of the anterior cruciate ligament (ACL) using multi-strand semitendinosus tendon for the purpose of getting better stability under aggressive rehabilitation by putting the graft in the normal anatomy with minimized notch-plasty. The drill guide position was determined using two-directional radiography in hyperextension. The two-bundle procedure was performed using the inside-out technique for grafting and

  1. Intraoperative comparisons of knee kinematics of double-bundle versus single-bundle anterior cruciate ligament reconstruction

    Microsoft Academic Search

    Stephane Plaweski; Mathieu Grimaldi; Aurélien Courvoisier; Simon Wimsey

    2011-01-01

    Purpose  Based on biomechanical anatomical studies, double-bundle reconstruction of the anterior cruciate ligament (ACL) was introduced\\u000a to achieve better stability in the knee, particularly in respect of rotatory loads. An in vivo, computer-assisted, double-bundle\\u000a (DB) ACL reconstruction is superior to a single-bundle (SB) ACL reconstruction at reducing rotatory, and AP laxities of the\\u000a tibia at 20 degrees of knee flexion and also

  2. Anterior cruciate ligament reconstruction using the Bio-TransFix femoral fixation device and anteromedial portal technique

    Microsoft Academic Search

    Michael E. Hantes; Zoe Dailiana; Vasilios C. Zachos; Sokratis E. Varitimidis

    2006-01-01

    The cross-pin femoral fixation technique for soft tissue grafts is a popular option in anterior cruciate ligament (ACL) reconstruction.\\u000a One of these devices is the Bio-TransFix (Arthrex Inc., Naples, FL, USA) which provides high fixation strength. According\\u000a to the manufacturer, the femoral tunnel is created by placing the femoral aiming device through the tibial tunnel (transtibial\\u000a technique). However, using this

  3. A systematic literature review to investigate if we identify those patients who can cope with anterior cruciate ligament deficiency

    Microsoft Academic Search

    Lee Herrington; Elizabeth Fowler

    2006-01-01

    Rupture of the anterior cruciate ligament (ACL) results in increased tibiofemoral laxity in the knee, thereby ultimately resulting in knee instability and dysfunction. However, ACL rupture does not automatically infer functional impairment and instability as confirmed by the ACL deficient (ACLD) coper, who can resume pre-morbid activity levels. Alternatively, an authentic ACLD non-coper is unable to return to pre-injury levels

  4. Magnetic Resonance Imaging of Bioabsorbable Polylactic Acid Interference Screws During the First 2 Years After Anterior Cruciate Ligament Reconstruction

    Microsoft Academic Search

    William H. Warden; Robert Friedman; Louis M. Teresi; Douglas W. Jackson

    1999-01-01

    Summary: Bioabsorbable screws composed of poly(L-lactic acid) (PLA) were used for graft fixation and studied prospectively with serial magnetic resonance imaging (MRI) scans at 8, 16, and 24 months after autogenous patellar tendon anterior cruciate ligament (ACL) reconstruction in 10 patients. Conventional spin echo, proton density , and T2-weighted double echo sequences were obtained, as well as T2-weighted fat-saturated fast

  5. Prevention of anterior cruciate ligament injuries in female basketball players in japan: an intervention study over four seasons

    Microsoft Academic Search

    Y Nagano; H Miki; K Tsuda; Y Shimizu; T Fukubayashi

    2011-01-01

    BackgroundFemale basketball players are at a higher risk of anterior cruciate ligament (ACL) injury than male players. Therefore, prevention of ACL injury in the former group is essential.ObjectiveTo assess the effect of an injury prevention training program on the incidence of ACL injuries in female basketball players.DesignProspective intervention study.SettingTop-level league in Japan.ParticipantsPlayers from 12 top-league teams. The control season (2006–2007)

  6. Anterior Cruciate Ligament Injury in National Collegiate Athletic Association Basketball and SoccerA 13Year Review

    Microsoft Academic Search

    Julie Agel; Elizabeth A. Arendt; Boris Bershadsky

    2005-01-01

    Background: Female collegiate athletes have been reported to have a higher rate of anterior cruciate ligament injury compared to male collegiate athletes. This finding has spawned a branch of research focused on understanding and preventing this injury pattern.Purpose: To determine if the trends reported in 1994 have continuedStudy Type: Descriptive epidemiology studyMethods: The National Collegiate Athletic Association Injury Surveillance System

  7. Football cleat design and its effect on anterior cruciate ligament injuries. A three-year prospective study.

    PubMed

    Lambson, R B; Barnhill, B S; Higgins, R W

    1996-01-01

    A 3-year prospective study was initiated to evaluate torsional resistance of modern football cleat designs and the incidence of surgically documented anterior cruciate ligament tears in high school football players wearing different cleat types. We compared four styles of football shoes and evaluated the incidence of anterior cruciate ligament tears among 3119 high school football players during the 1989 to 1991 competitive seasons. The four cleat designs were 1) Edge, longer irregular cleats placed at the peripheral margin of the sole with a number of smaller pointed cleats positioned interiorly (number of players wearing this shoe, 2231); 2) Flat, cleats on the forefoot are the same height, shape, and diameter, such as found on the soccer-style shoe (N = 832); 3) Screw-in, seven screw-in cleats of 0.5 inch height and 0.5 inch diameter (N = 46); and 4) Pivot disk, a 10-cm circular edge is on the sole of the forefoot, with one 0.5-inch cleat in the center (N = 10). The results showed that the Edge design produced significantly higher torsional resistance than the other designs (P < 0.05) and was associated with a significantly higher anterior cruciate ligament injury rate (0.017%) than the other three designs combined (0.005%). PMID:8775112

  8. Anterior cruciate ligament repair with LARS (ligament advanced reinforcement system): a systematic review

    PubMed Central

    2010-01-01

    Background Injury to the anterior cruciate ligament (ACL) of the knee is common. Following complete rupture of the ACL, insufficient re-vascularization of the ligament prevents it from healing completely, creating a need for reconstruction. A variety of grafts are available for use in ACL reconstruction surgery, including synthetic grafts. Over the last two decades new types of synthetic ligaments have been developed. One of these synthetic ligaments, the Ligament Advanced Reinforcement System (LARS), has recently gained popularity. The aim of this systematic review was to assess the current best available evidence for the effectiveness of the LARS as a surgical option for symptomatic, anterior cruciate ligament rupture in terms of graft stability, rehabilitation time and return to pre-injury function. Method This systematic review included studies using subjects with symptomatic, ACL ruptures undergoing LARS reconstruction. A range of electronic databases were searched in May 2010. The methodological quality of studies was appraised with a modified version of the Law critical appraisal tool. Data relating to study characteristics, surgical times, complication rates, outcomes related to knee stability, quality of life, function, and return to sport as well as details of rehabilitation programs and timeframes were collected. Results This review identified four studies of various designs, of a moderate methodological quality. Only one case of knee synovitis was reported. Patient satisfaction with LARS was high. Graft stability outcomes were found to be inconsistent both at post operative and at follow up periods. The time frames of rehabilitation periods were poorly reported and at times omitted. Return to pre-injury function and activity was often discussed but not reported in results. Conclusions There is an emerging body of evidence for LARS with comparable complication rates to traditional surgical techniques, and high patient satisfaction scores. However, this systematic review has highlighted several important gaps in the existing literature that require future prospective investigation. The findings of this review were equivocal with regards to other measures such as graft stability and long term functional outcomes. While the importance of rehabilitation following LARS is well recognised, there is limited evidence to guide rehabilitation protocols. PMID:21138589

  9. A matched pairs comparison of single- versus double-bundle anterior cruciate ligament reconstructions, clinical results and manual laxity testing

    Microsoft Academic Search

    R. SieboldT; T. P. Branch; H. I. Freedberg; C. A. Jacobs

    Purpose  To compare the subjective clinical results as well as manual anterior and rotational stability in patients treated with either\\u000a single- (SB) or double-bundle (DB) anterior cruciate ligament (ACL) reconstructions.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Sixty-four patients who had undergone SB or DB hamstring ACL reconstruction with hamstrings were included in a retrospective\\u000a matched pair analysis. At follow-up IKDC subjective, CKS, KOOS, CKS and a visual

  10. Hamstrings Stiffness and Landing Biomechanics Linked to Anterior Cruciate Ligament Loading

    PubMed Central

    Blackburn, J. Troy; Norcross, Marc F.; Cannon, Lindsey N.; Zinder, Steven M.

    2013-01-01

    Context: Greater hamstrings stiffness is associated with less anterior tibial translation during controlled perturbations. However, it is unclear how hamstrings stiffness influences anterior cruciate ligament (ACL) loading mechanisms during dynamic tasks. Objective: To evaluate the influence of hamstrings stiffness on landing biomechanics related to ACL injury. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: A total of 36 healthy, physically active volunteers (18 men, 18 women; age = 23 ± 3 years, height = 1.8 ± 0.1 m, mass = 73.1 ± 16.6 kg). Intervention(s): Hamstrings stiffness was quantified via the damped oscillatory technique. Three-dimensional lower extremity kinematics and kinetics were captured during a double-legged jump-landing task via a 3-dimensional motion-capture system interfaced with a force plate. Landing biomechanics were compared between groups displaying high and low hamstrings stiffness via independent-samples t tests. Main Outcome Measure(s): Hamstrings stiffness was normalized to body mass (N/m·kg?1). Peak knee-flexion and -valgus angles, vertical and posterior ground reaction forces, anterior tibial shear force, internal knee-extension and -varus moments, and knee-flexion angles at the instants of each peak kinetic variable were identified during the landing task. Forces were normalized to body weight, whereas moments were normalized to the product of weight and height. Results: Internal knee-varus moment was 3.6 times smaller in the high-stiffness group (t22 = 2.221, P = .02). A trend in the data also indicated that peak anterior tibial shear force was 1.1 times smaller in the high-stiffness group (t22 = 1.537, P = .07). The high-stiffness group also demonstrated greater knee flexion at the instants of peak anterior tibial shear force and internal knee-extension and -varus moments (t22 range = 1.729–2.224, P < .05). Conclusions: Greater hamstrings stiffness was associated with landing biomechanics consistent with less ACL loading and injury risk. Musculotendinous stiffness is a modifiable characteristic; thus exercises that enhance hamstrings stiffness may be important additions to ACL injury-prevention programs. PMID:24303987

  11. A Comparison of Functional Outcomes After Metallic and Bioabsorbable Interference Screw Fixations in Arthroscopic ACL Reconstructions

    PubMed Central

    Rai, Deepak K; Kannampilly, Antony J

    2014-01-01

    Introduction: Anterior Cruciate Ligament (ACL) is as one of the most frequently injured ligaments in the modern contact sports scenario. Graft fixations can be achieved during anterior cruciate ligament (ACL) reconstructions by using either bioabsorbable screws or metal screws. The objective of this study was to compare the functional outcomes after bioabsorbable and metallic interference screw fixations in arthroscopic anterior cruciate ligament reconstructions done by using hamstring grafts. Materials and Methods: This was a prospective, randomized study. Patients in Group 1 received bioabsorbable interference screws and patients in Group 2 received metallic interference screws. Arthroscopic assisted, anterior cruciate ligament reconstructions with the use of hamstring grafts which were fixed proximally with endobuttons and distally with bioabsorbable or metallic interference screws, were undertaken. Progress in functional outcomes was assessed by using Mann Whitney U- test. Functional outcomes in the two groups were compared by using independent t-test. Observation and Results: In each group, there were statistically significant improvements in functional outcomes over successive follow-ups, which were seen on basis on Mann-Whitney U-test. The comparison of functional outcomes between the two groups, done by using independent t-test, showed no statistically significant differences between the two groups at 3 months, 6 months and 1 year of follow-up. p-value <0.05 was considered to be significant in our study. Conclusion: In our prospective study of comparison of functional outcomes between bioabsorbable and metallic interference screws in arthroscopic anterior cruciate ligament reconstuctions, which were evaluated by using Tegner activity scale and Lysholm knee scoring scale for a period of 1 year, no statistically significant difference was found. However, further authentication is required by doing long term studies. PMID:24959468

  12. Bone-patellar tendon-bone autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction.

    PubMed

    Pan, Xiaoyun; Wen, Hong; Wang, Lide; Ge, Tichi

    2013-10-01

    The optimized graft for use in anterior cruciate ligament (ACL) reconstruction is still in controversy. The bone-patellar tendon-bone (BPTB) autograft has been accepted as the gold standard for ACL reconstruction. However, donor site morbidities cannot be avoided after this treatment. The artificial ligament of ligament advanced reinforcement system (LARS) has been recommended for ACL reconstruction. The purpose of this study is to compare the midterm outcome of ACL reconstruction using BPTB autografts or LARS ligaments. Between July 2004 and March 2006, the ACL reconstruction using BPTB autografts in 30 patients and LARS ligaments in 32 patients was performed. All patients were followed up for at least 4 years and evaluated using the Lysholm knee score, Tegner score, International Knee Documentation Committee (IKDC) score, and KT-1000 arthrometer test. There were no significant differences between the two groups with respect to the data of Lysholm scores, Tegner scores, IKDC scores, and KT-1000 arthrometer test at the latest follow-up. Our study demonstrates that the similarly good clinical results are obtained after ACL reconstruction using BPTB autografts or LARS ligaments at midterm follow-up. In addition to BPTB autografts, the LARS ligament may be a satisfactory treatment option for ACL rupture. PMID:23412205

  13. A rare case of giant cell tumour arising from anterior cruciate ligament: Its diagnosis and management.

    PubMed

    Agarwala, Sanjay; Agrawal, Pranshu; Moonot, Pradeep; Sobti, Anshul

    2015-06-01

    Tenosynovial giant cell tumour is a locally aggressive tumour arising from the synovia of the fibrous tissue surrounding the joints, tendon sheaths and tendons. Areas of predilection are the hand, and in the case of synovial joints, the knee joint is particularly affected. We describe a rare case of an intra-articular localized tenosynovial giant cell tumour arising from the anterior cruciate ligament (ACL) in a 27 year male who presented with pain and giving way of his left knee without prior history of any trauma. Tests for internal derangement of knee were negative. MRI reported an ACL tear with a heterogeneous fibrous mass attached to the distal part, most probably an organized haematoma. It was decided to do a diagnostic arthroscopy before proceeding for ACL reconstruction. Arthroscopy revealed a purple coloured mass attached to distal part of ACL. The mass was removed piecemeal using an additional posterolateral portal. ACL was found intact. Histopathology reported it to be tenosynovial giant cell tumour. The patient was asymptomatic at each subsequent follow up. It is a rare diagnosis which presented as an ACL tear; in such suspected cases it is prudent to perform a diagnostic arthroscopy before going for ACL reconstruction. PMID:25983523

  14. Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature

    PubMed Central

    Ventura, Alberto; Terzaghi, Clara; Borgo, Enrico; Albisetti, Walter

    2010-01-01

    Anterior cruciate ligament (ACL) rupture, one of the most common knee injuries in sports, results in anteroposterior laxity, which often leads to an unstable knee. Traditional ACL reconstruction is performed with autograft; disadvantages of this technique are donor site morbidity and a long rehabilitation period. In the 1980s, artificial ligaments became an attractive alternative to biological grafts. The initial enthusiasm surrounding their introduction stemmed from their lack of donor morbidity, their abundant supply and significant strength, immediate loading and reduced postoperative rehabilitation. Synthetic grafts made of different materials such as carbon fibers, polypropylene, Dacron and polyester have been utilised either as a prosthesis or as an augmentation for a biological ACL graft substitute. Nevertheless, every material presented serious drawbacks: cross-infections, immunological responses, breakage, debris dispersion leading to synovitis, chronic effusions, recurrent instability and knee osteoarthritis. Recently, a resurgence of interest in the use of synthetic prostheses has occurred and studies regarding new artificial grafts have been reported. Although many experimental studies have been made and much effort has been put forth, currently no ideal prosthesis mimicking natural human tissue has been found. PMID:20157811

  15. Evaluation of manual test for anterior cruciate ligament injury using a body-mounted sensor

    NASA Astrophysics Data System (ADS)

    Yoshida, R.; Sagawa, K.; Tsukamoto, T.; Ishibashi, Y.

    2007-12-01

    Diagnosis method of anterior cruciate ligament (ACL) using body-mounted sensor is discussed. A wide variety of diagnosis method such as Pivot Shift Test (PST), Lachman Test and monitoring of jump motion (JT) are applied to examine the injured ACL. These methods, however, depend on the ability and the experience of examiner. The proposed method numerically provides three dimensional translation and rotation of the knee by using a newly developed 3D sensor. The 3D sensor is composed of three accelerometers and three gyroscopes. Measured acceleration of the knee during the examination is converted to the fixed system of coordinate according the acceleration of gravity and 3D rotation of the sensor, and is numerically integrated to derive 3D trajectory and rotation angle around the tibia. The experimental results of JT suggest that unsymmetrical movement of rotation angle of the tibia and sudden movement of estimated 3D trajectory show instability of knee joint. From the results of PST analysis, it is observed that the tibial angular velocity around the flexed position changes 41.6 [deg/s] at the injured side and 21.7 [deg/s] at the intact side. This result suggests the reposition of injured knee from subluxation.

  16. Pre-operative planning in anterior cruciate ligament reconstruction revision surgery.

    PubMed

    Adriani, Ezio; Summa, Pierpaolo; Di Paola, Berardino

    2013-03-01

    Primary reconstructions of the anterior cruciate ligament are common and increasing in number, a trend inevitably paralleled by an increase in the number of revision procedures. Failure of primary ACL reconstruction can appear as objective residual laxity, subjective instability, severe and persistent postoperative stiffness and/or pain, or infection. Revision surgery is a complex procedure, in which the expected clinical outcome is inferior to that which can be expected from primary reconstruction, and patients have a 5.4% risk of undergoing a second revision after five years. This type of procedure demands correct and exhaustive preoperative planning so as ensure optimal treatment of accompanying lesions and of any complications arising during surgery. It is important to know, in detail, the patient's clinical history (when the primary surgery was performed and the technique used, the cause of the recurrence, the degree of functional recovery, etc.), to perform a thorough clinical examination (to evaluate alignment, gait cycle, skin color, the trophic condition of the muscles, joint laxity), and to have available the results of a detailed and specific imaging study and also of blood tests, in order to exclude the presence of an infection. PMID:25606508

  17. In vitro study on silk fibroin textile structure for anterior cruciate ligament regeneration.

    PubMed

    Farè, Silvia; Torricelli, Paola; Giavaresi, Gianluca; Bertoldi, Serena; Alessandrino, Antonio; Villa, Tomaso; Fini, Milena; Tanzi, Maria Cristina; Freddi, Giuliano

    2013-10-01

    A novel hierarchical textile structure made of silk fibroin from Bombyx mori capable of matching the mechanical performance requirements of anterior cruciate ligament (ACL) and in vitro cell ingrowth is described. This sericin-free, Silk Fibroin Knitted Sheath with Braided Core (SF-KSBC) structure was fabricated using available textile technologies. Micro-CT analysis confirmed that the core was highly porous and had a higher degree of interconnectivity than that observed for the sheath. The in vivo cell colonization of the scaffolds is thus expected to penetrate even the internal parts of the structure. Tensile mechanical tests demonstrated a maximum load of 1212.4±56.4 N (under hydrated conditions), confirming the scaffold's suitability for ACL reconstruction. The absence of cytotoxic substances in the extracts of the SF-KSBC structure in culture medium was verified by in vitro tests with L929 fibroblasts. In terms of extracellular matrix production, Human Periodontal Ligament Fibroblasts (HPdLFs) cultured in direct contact with SF-KSBC, compared to control samples, demonstrated an increased secretion of aggrecan (PG) and fibronectin (FBN) at 3 and 7 days of culture, and no change in IL-6 and TNF-? secretion. Altogether, the outcomes of this investigation confirm the significant utility of this novel scaffold for ACL tissue regeneration. PMID:23910255

  18. Outcome of combined autologous chondrocyte implantation and anterior cruciate ligament reconstruction

    PubMed Central

    Dhinsa, Baljinder S; Nawaz, Syed Z; Gallagher, Kieran R; Skinner, John; Briggs, Tim; Bentley, George

    2015-01-01

    Background: Instability of the knee joint, after anterior cruciate ligament (ACL) injury, is contraindication to osteochondral defect repair. This prospective study is to investigate the role of combined autologous chondrocyte implantation (ACI) with ACL reconstruction. Materials and Methods: Three independent groups of patients with previous ACL injuries undergoing ACI were identified and prospectively followed up. The first group had ACI in combination with ACL reconstruction (combined group); the 2nd group consisted of individuals who had an ACI procedure having had a previously successful ACL reconstruction (ACL first group); and the third group included patients who had an ACI procedure to a clinically stable knee with documented nonreconstructed ACL disruption (No ACL group). Their outcomes were assessed using the modified cincinnati rating system, the Bentley functional (BF) rating system (BF) and a visual analog scale (VAS). Results: At a mean followup of 64.24 months for the ACL first group, 63 months for combined group and 78.33 months for the No ACL group; 60% of ACL first patients, 72.73% of combined group and 83.33% of the No ACL group felt their outcome was better following surgery. There was no significant difference demonstrated in BF and VAS between the combined and ACL first groups. Results revealed a significant affect of osteochondral defect size on outcome measures. Conclusion: The study confirms that ACI in combination with ACL reconstruction is a viable option with similar outcomes as those patients who have had the procedures staged. PMID:26015603

  19. Review of evolution of tunnel position in anterior cruciate ligament reconstruction

    PubMed Central

    Rayan, Faizal; Nanjayan, Shashi Kumar; Quah, Conal; Ramoutar, Darryl; Konan, Sujith; Haddad, Fares S

    2015-01-01

    Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established. PMID:25793165

  20. The Effects of Rehabilitation Protocol on Functional Recovery After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Dragicevic-Cvjetkovic, Dragana; Jandric, Slavica; Bijeljac, Sinisa; Palija, Stanislav; Manojlovic, Slavko; Talic, Goran

    2014-01-01

    ABSTRACT Introduction: The use of rehabilitation protocol which corresponds to surgical technique results in optimal postoperative outcome and functional recovery of patients to a pre-injury level of activity. The aim of this paper is to show the effects of the official rehabilitation protocol in our Institute on functional recovery of patients after anterior cruciate ligament (ACL) reconstruction. Patients and methods: In prospective study, we evaluated 70 males after ACL reconstruction using hamstring graft. Patients were divided into two groups according to the manner of conducting the postoperative rehabilitation. Group A consisted of 35 patients that followed postoperative rehabilitation according to the rehabilitation protocol. Group B also 35 patients, which did not undergo the rehabilitation protocol. We evaluated thigh muscle circumference and modified Tegner Lysholm Score, preoperatively and postoperatively after 1,3,6 and 12 months. In the statistical analysis, the Studentov T-test was used. Results: In the first postoperative month, the difference between groups in thigh muscle circumference is statistically significant (p<0,05). This difference between groups is statistically highly significant after 3, 6, and 12 months postoperative (p<0,01). Results of the modified Tegner Lysholm Score is statistically highly significant in 1, 3 and 6 postoperative months in patients from the experimental group (p<0,01). Conclusion: The positive effects of the rehabilitation protocol results in significant increase of the thigh muscle circumference and faster functional recovery of patients after ACL reconstruction. PMID:25568570

  1. Self-Protective Changes in Athletic Identity Following Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Brewer, Britton W.; Cornelius, Allen E.

    2009-01-01

    Objectives This study was designed to examine the possibility of self-protective changes in athletic identity (AI) being initiated after the occurrence of a severe injury. Method People (72 men and 36 women) undergoing anterior cruciate ligament (ACL) surgery and rehabilitation were asked to complete a measure of AI prior to surgery and measures of AI and rehabilitation progress at approximately 6, 12, and 24 months after surgery. Results A repeated-measures ANCOVA controlling for age and gender indicated that AI decreased significantly across the 24-month period following surgery, with the most substantial decline occurring between 6 and 12 months postsurgery. Significantly greater decreases in AI were observed among participants whose rehabilitation progress was slowest from 6 to 12 months postsurgery. Conclusions The findings suggest that some participants reduced their identification with the athlete role in response to the threat to a positive self-image posed by their ACL injuries and the difficulties they encountered in postoperative rehabilitation. PMID:20161402

  2. Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: basketball.

    PubMed

    Waters, Eric

    2012-04-01

    The purpose of this paper is to outline the final, functional phases of rehabilitation that address exercises, drills, and return-to-play criteria for the sport of basketball, following anterior cruciate ligament (ACL) reconstruction. ACL injuries can be debilitating and affect the quality of life for recreational and elite athletes alike. Tears of the ACL are common in both male and female basketball players, with a higher incidence rate in females. Incidence of a retear to the existing graft or contralateral knee within 5 years of ACL reconstruction with patellar tendon autograft in young (less than 18 to 25 years of age), active basketball players can be as high as 52%. Reducing the number of ACL injuries or reinjury, of which there are an estimated 80 000 per year at an associated cost of over a billion dollars, can have significant potential long-term fiscal and health benefits. Following surgical reconstruction of the ACL, implementing a tailored rehabilitation protocol can ensure a successful return to sport. When searching the literature for such protocols, clinicians may struggle to find specific exercises, drills, and return-to-play criteria for particular sports. The intent of this manuscript is to present such a rehabilitation protocol for basketball. PMID:22465899

  3. All-Epiphyseal, All-Inside Anterior Cruciate Ligament Reconstruction Technique for Skeletally Immature Patients

    PubMed Central

    McCarthy, Moira M.; Graziano, Jessica; Green, Daniel W.; Cordasco, Frank A.

    2012-01-01

    Anterior cruciate ligament (ACL) injuries are an increasingly recognized problem in the juvenile population. Unfortunately, outcomes with conservative treatment are extremely poor. Adult reconstruction techniques are inappropriate to treat skeletally immature patients because of the risk of physeal complications, including limb-length discrepancy and angular deformities. “Physeal-sparing” reconstruction techniques exist, but their ability to restore knee stability is not well understood. We describe an all-epiphyseal ACL reconstruction for use in skeletally immature patients. This is an all-inside technique with the femoral tunnel drilled retrograde and the tibial tunnel drilled retrograde; both tunnels are entirely within the epiphysis. Fixation of the hamstring autograft is achieved with soft-tissue buttons on both the femur and tibia. We present case examples for 2 patients who underwent the all-inside, all-epiphyseal reconstruction and our postoperative rehabilitation protocol. We present a novel surgical technique for an all-inside, all-epiphyseal ACL reconstruction in skeletally immature patients. PMID:23767001

  4. Anterior cruciate ligament laxity related to the menstrual cycle: an updated systematic review of the literature

    PubMed Central

    Belanger, Lesley; Burt, Dawn; Callaghan, Julia; Clifton, Sheena; Gleberzon, Brian J.

    2013-01-01

    Objectives: The purpose of this study was to conduct a systematic review regarding the purported differences in anterior cruciate ligament (ACL) laxity throughout the course of the menstrual cycle. Methods: A systematic review was performed by searching electronic databases, along with hand-searching of journals and reference tracking for any study that assessed ACL integrity throughout the menstrual cycle from 1998 until 2011. Studies that met the pre-defined inclusion criteria were evaluated using the Modified Sackett Score (MSS) instrument that assessed their methodological quality. Results: Thirteen articles out of a possible 28 met the inclusion criteria. Conclusions: This systematic review found 13 clinical trials investigating the effect of the menstrual cycle on ACL laxity. There is evidence to support the hypothesis that the ACL changes throughout the menstrual cycle, with it becoming more lax during the pre-ovulatory (luteal) phase. Overall, these reviews found statistically significant differences for variation in ACL laxity and injury throughout the menstrual cycle, especially during the pre-ovulatory phase. Female athletes may need to take precautions in order to reduce the likelihood of ACL injury. However, the quality of the assessments was low and the evidence is still very limited. More and better quality research is needed in this area. PMID:23483028

  5. Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction.

    PubMed

    Uçar, Mehmet; Koca, Irfan; Eroglu, Mehmet; Eroglu, Selma; Sarp, Umit; Arik, Hasan Onur; Yetisgin, Alparslan

    2014-12-01

    [Purpose] To compare outcomes of anterior cruciate ligament (ACL) reconstruction after open kinetic chain (OKC) exercises and closed kinetic chain (CKC) exercises. [Subjects and Methods] The subjects comprised 11 female and 47 male patients who are randomly divided into two groups: which performed a CKC exercise program Group I and Group II which performed an OKC exercise program. Pain intensity was evaluated using visual analogue scale (VAS). Knee flexion was evaluated using a universal goniometer, and thigh circumference measurements were taken with a tape measure at baseline and at 3 months and 6 months after the treatment. Lysholm scores were used to assess knee function. [Results] There were no significant differences between the two groups at baseline. Within each group, VAS values and knee flexion were improved after the surgery. These improvements were significantly higher in the CKC group than in the OKC group. There were increases in thigh circumference difference at the 3 and 6 month assessments post-surgery. A greater improvement in the Lysholm score was observed in the CKC group at 6 months. [Conclusion] The CKC exercise program was more effective than OKC in improving the knee functions of patients with ACL reconstruction. PMID:25540486

  6. Anterior cruciate ligament injury after more than 20 years. II. Concentric and eccentric knee muscle strength.

    PubMed

    Tengman, E; Brax Olofsson, L; Stensdotter, A K; Nilsson, K G; Häger, C K

    2014-12-01

    The long-term consequences on knee muscle strength some decades after rupture of the anterior cruciate ligament (ACL) are not established. The aims of our study were to examine peak torque more than 20 years after ACL injury and to compare their knee muscle strength to that of healthy controls. We tested 70 individuals with unilateral ACL injury 23?±?2 years after injury, whereof 33 (21 men) were treated with physiotherapy in combination with ACL reconstruction (ACLR ) and 37 (23 men) with physiotherapy alone (ACLPT ). These were compared with 33 age- and gender-matched controls (21 men). A Kin-Com(®) dynamometer (90°/s) was used to measure peak torque in knee flexion and extension in both concentric and eccentric contractions. Knee extension peak torque, concentric and eccentric, was ?10% lower for the injured leg compared with the non-injured leg for both ACLR (P?

  7. Three-Dimensional Fluoroscopic Navigation Guidance for Femoral Tunnel Creation in Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Taketomi, Shuji; Inui, Hiroshi; Nakamura, Kensuke; Hirota, Jinso; Takei, Seira; Takeda, Hideki; Tanaka, Sakae; Nakagawa, Takumi

    2012-01-01

    Revision anterior cruciate ligament (ACL) reconstruction is accompanied by several technical challenges that must be addressed, such as a primary malpositioned bone tunnel, pre-existing hardware, or bone defects due to tunnel expansion. We describe a surgical technique used to create an anatomic femoral socket using a 3-dimensional (3D) fluoroscopy-based navigation system in technically demanding revision cases. After a reference frame is rigidly attached to the femur, an intraoperative image of the distal femur is obtained, which is transferred to a navigation system and reconstructed into a 3D image. A navigation computer helps the surgeon to visualize the whole image of the lateral wall of the femoral notch, even if the natural morphology of the intercondylar notch has been destroyed by the primary procedure. In addition, the surgeon can also confirm the position of the previous bone tunnel aperture, the previous exit of the femoral tunnel, and the presence of any pre-existing hardware on the navigation monitor. When a new femoral guidewire for the revision procedure is placed, the virtual femoral tunnel is overlaid on the reconstructed 3D image in real time. At our institution, 12 patients underwent 1-stage revision ACL procedures with the assistance of this computer navigation system, and the grafts were securely fixed in anatomically created tunnels in all cases. This technology can assist surgeons in creating anatomic femoral tunnels in technically challenging revision ACL reconstructions. PMID:23766985

  8. Evaluation of Open and Closed Kinetic Chain Exercises in Rehabilitation Following Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Uçar, Mehmet; Koca, Irfan; Eroglu, Mehmet; Eroglu, Selma; Sarp, Umit; Arik, Hasan Onur; Yetisgin, Alparslan

    2014-01-01

    [Purpose] To compare outcomes of anterior cruciate ligament (ACL) reconstruction after open kinetic chain (OKC) exercises and closed kinetic chain (CKC) exercises. [Subjects and Methods] The subjects comprised 11 female and 47 male patients who are randomly divided into two groups: which performed a CKC exercise program Group I and Group II which performed an OKC exercise program. Pain intensity was evaluated using visual analogue scale (VAS). Knee flexion was evaluated using a universal goniometer, and thigh circumference measurements were taken with a tape measure at baseline and at 3 months and 6 months after the treatment. Lysholm scores were used to assess knee function. [Results] There were no significant differences between the two groups at baseline. Within each group, VAS values and knee flexion were improved after the surgery. These improvements were significantly higher in the CKC group than in the OKC group. There were increases in thigh circumference difference at the 3 and 6 month assessments post-surgery. A greater improvement in the Lysholm score was observed in the CKC group at 6 months. [Conclusion] The CKC exercise program was more effective than OKC in improving the knee functions of patients with ACL reconstruction. PMID:25540486

  9. The effects of immobilization on the maturation of the anterior cruciate ligament of the rabbit knee.

    PubMed Central

    Amiel, D.; Wallace, C. D.; Harwood, F. L.

    1994-01-01

    Immobilization-induced alterations occurred in young anterior cruciate ligament (ACL) samples, including the loss of the rounded appearance of the cells. The mature ACL was minimally altered by immobilization at the light microscopy level. In the immobilized young ACL the fibroblasts became elongated and there was loss of the normal pericellular matrix. The immobilized mature ACL differed from controls primarily in the intracellular composition, as there was significantly more rough endoplasmic reticulum (RER) present. Collagen concentrations were reduced only in young immobilized ACL, while no differences were observed in the mature ACL. The collagen synthesis rate in the mature ACL increased with immobilization, although no significant change was observed in the young ACL. The increase in the rate of synthesis of the stress deprived ACL in the mature animals reflected an increase in collagen turnover rather than an increase in accumulation of collagen. Images Figure 1 Figure 2 Figure 3 Figure 4A Figure 4B Figure 5A Figure 5B PMID:7719768

  10. Long-term outcomes of allograft reconstruction of the anterior cruciate ligament.

    PubMed

    Lenehan, Eric A; Payne, W Barrett; Askam, Brad M; Grana, William A; Farrow, Lutul D

    2015-05-01

    Recent studies have found higher rates of failed reconstruction of the anterior cruciate ligament (ACL) with use of allograft when compared with autograft reconstruction. To evaluate the long-term outcomes of allograft ACL reconstruction, we retrospectively reviewed the cases of all patients who underwent allograft (n = 99) or autograft (n = 24) ACL reconstruction by 2 senior surgeons at a single institution over an 8-year period. Seventeen (17%) of the 99 allograft reconstructions required additional surgery. Reoperation and revision ACL reconstruction rates (30.8% and 20.5%, respectively) were much higher for patients 25 years of age or younger than for patients older than 25 years. In our cohort of NCAA (National Collegiate Athletic Association) Division I athletes, the revision ACL reconstruction rate was 62% for allograft ACL reconstruction and 0% for autograft reconstruction. Our study found that reoperation and revision rates for irradiated soft-tissue allograft ACL reconstruction were higher than generally quoted for autograft reconstruction. Given the extremely high graft failure rates in patients younger than 25 years, we recommend against routine use of irradiated soft-tissue allograft for ACL reconstruction in younger patients. PMID:25950536

  11. Predictors of Adherence to Home Rehabilitation Exercises Following Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Brewer, Britton W.; Cornelius, Allen E.; Van Raalte, Judy L.; Tennen, Howard; Armeli, Stephen

    2014-01-01

    Purpose/Objective Although home exercises are commonly prescribed following anterior cruciate ligament (ACL) reconstruction and are considered important in obtaining successful rehabilitation outcomes, little is known about factors associated with the completion of such exercises. Consequently, this study was designed to identify predictors of adherence to home rehabilitation exercises after ACL surgery. Research Method/Design Participants (33 women, 58 men) completed indices of athletic identity, neuroticism, optimism, and pessimism before ACL surgery and measures of daily pain, negative mood, stress, and home exercise completion for 42 days postoperatively. Results Participants reported a high level of adherence to the prescribed regimen. Home exercise completion increased significantly over time as the number of sets of prescribed home exercises declined. Personal factors were not predictive of home exercise completion. Participants completed fewer home exercises on days when they experienced more stress or negative mood. Conclusions/Implications Day-to-day variations in negative mood and stress may contribute to adherence to prescribed home exercises. PMID:23438001

  12. Trends in primary and revision anterior cruciate ligament reconstruction among National Basketball Association team physicians.

    PubMed

    Mall, Nathan A; Abrams, Geoffrey D; Azar, Frederick M; Traina, Steve M; Allen, Answorth A; Parker, Richard; Cole, Brian J

    2014-06-01

    Anterior cruciate ligament (ACL) tears are common in athletes. Techniques and methods of treatment for these injuries continue to vary among surgeons. Thirty National Basketball Association (NBA) team physicians were surveyed during the NBA Pre-Draft Combine. Survey questions involved current and previous practice methods of primary and revision ACL reconstruction, including technique, graft choice, rehabilitation, and treatment of combined ACL and medial collateral ligament injuries. Descriptive parametric statistics, Fisher exact test, and logistic regression were used, and significance was set at ? = 0.05. All 30 team physicians completed the survey. Eighty-seven percent indicated they use autograft (81% bone-patellar tendon-bone) for primary ACL reconstruction in NBA athletes, and 43% indicated they use autograft for revision cases. Fourteen surgeons (47%) indicated they use an anteromedial portal (AMP) for femoral tunnel drilling, whereas 5 years earlier only 4 (13%) used this technique. There was a significant (P = .009) positive correlation between fewer years in practice and AMP use. NBA team physicians' use of an AMP for femoral tunnel drilling has increased over the past 5 years. PMID:24945476

  13. A biodegradable tri-component graft for anterior cruciate ligament reconstruction.

    PubMed

    Chung, Eun Ji; Sugimoto, Matthew J; Koh, Jason L; Ameer, Guillermo A

    2014-11-21

    Bone-patellar tendon-bone (BPTB) autografts are the gold standard for anterior cruciate ligament (ACL) reconstruction because the bony ends allow for superior healing and anchoring through bone-to-bone regeneration. However, the disadvantages of BPTB grafts include donor site morbidity and patellar rupture. In order to incorporate bone-to-bone healing without the risks associated with harvesting autogenous tissue, a biodegradable and synthetic tri-component graft was fabricated, consisting of porous poly(1,8-octanediol-co-citric acid)-hydroxyapatite nanocomposites (POC-HA) and poly(l-lactide) (PLL) braids. All regions of the tri-component graft were porous and the tensile properties were in the range of the native ACL. When these novel grafts were used to reconstruct the ACL of rabbits, all animals after 6?weeks were weight-bearing and showed good functionality. Histological assessment confirmed tissue infiltration throughout the entire scaffold and tissue ingrowth and interlocking within the bone tunnels, which is favourable for graft fixation. In conclusion, this pilot study suggests that a tri-component, biodegradable graft is a promising strategy to regenerate tissue types necessary for ACL tissue engineering, and provides a basis for developing an off-the-shelf graft for ACL repair. Copyright © 2014 John Wiley & Sons, Ltd. PMID:25414080

  14. Hybrid Graft Anterior Cruciate Ligament Reconstruction: A Predictable Graft for Knee Stabilization.

    PubMed

    Alvarez-Pinzon, Andres M; Barksdale, Leticia; Krill, Michael K; Leo, Brian M

    2015-06-01

    Trauma to the anterior cruciate ligament (ACL) is a season-ending injury and involves months of activity modification and rehabilitation. The annual incidence of ACL tears in the United States is approximately 200,000, which allows for a broad range of individualized treatment options. Various surgical techniques, including transtibial and independent tunnel drilling, allograft and autograft tissue, and various implants, have been described in the literature. This article describes the indications and technique for a hybrid soft tissue graft for ACL reconstruction. Autologous grafts eliminate the risk of disease transmission and have recently been shown to have a lower rerupture rate, particularly in younger, active patients; however, the harvesting of autologous hamstring grafts carries a risk of donor-site morbidity, iatrogenic injury of the graft, and inadequate graft size. In contrast to a traditional autologous soft tissue graft, the hybrid graft allows for graft size customization for a desired reconstruction, especially in cases where autograft hamstrings may be iatrogenically damaged or of inadequate size when harvested. The goal of a hybrid graft ACL reconstruction is to provide a favorable-sized graft with clinical outcomes comparable with autologous soft tissue grafts. In contrast to a traditional autologous soft tissue graft, this technique provides another option in the event of unforeseen deficiencies or complications associated with harvesting and preparation of the autologous gracilis and semitendinosis soft tissue graft. [Orthopedics. 2015; 38(6):e473-e476.]. PMID:26091219

  15. Review of evolution of tunnel position in anterior cruciate ligament reconstruction.

    PubMed

    Rayan, Faizal; Nanjayan, Shashi Kumar; Quah, Conal; Ramoutar, Darryl; Konan, Sujith; Haddad, Fares S

    2015-03-18

    Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established. PMID:25793165

  16. Implementation of open and closed kinetic chain quadriceps strengthening exercises after anterior cruciate ligament reconstruction.

    PubMed

    Ross, M D; Denegar, C R; Winzenried, J A

    2001-11-01

    When working with athletes that have recently undergone anterior cruciate ligament (ACL) reconstructive surgery, a common goal of athletic trainers, strength and conditioning coaches, physicians, and physical therapists is to restore quadriceps strength while protecting the reconstructed ACL and patellofemoral joint from unnecessary stresses. Quadriceps strengthening exercises are often referred to as occurring in the open kinetic chain (OKC) or closed kinetic chain (CKC). Currently, there is little agreement in the literature as to whether only CKC exercises or a combination of OKC and CKC exercise should be performed after ACL reconstruction to strengthen the quadriceps. We believe that a combination of OKC and CKC exercises can be used to effectively and safely strengthen the quadriceps after ACL reconstruction. The purposes of this review are to examine the scientific literature currently available for the effects of OKC and CKC exercise on ACL strain and patellofemoral joint stress, and to present a sound rationale for using a combination of OKC and CKC exercises for quadriceps strengthening after ACL reconstruction. On the basis of our review, both OKC and CKC exercises can be modified and implemented for quadriceps strengthening after ACL reconstruction without causing excessive ACL strain or patellofemoral joint stress. PMID:11726258

  17. Adaptations in single-leg hop biomechanics following anterior cruciate ligament reconstruction.

    PubMed

    Orishimo, Karl F; Kremenic, Ian J; Mullaney, Michael J; McHugh, Malachy P; Nicholas, Stephen J

    2010-11-01

    When a patient performs a clinically normal hop test based on distance, it cannot be assumed that the biomechanics are similar between limbs. The objective was to compare takeoff and landing biomechanics between legs in patients who have undergone anterior cruciate ligament reconstruction. Kinematics and ground reaction forces were recorded as 13 patients performed the single-leg hop on each leg. Distance hopped, joint range of motion, peak joint kinetics and the peak total extensor moment were compared between legs during both takeoff and landing. Average hop distance ratio (involved/noninvolved) was 93 ± 4%. Compared to the noninvolved side, knee motion during takeoff on the involved side was significantly reduced (P = 0.008). Peak moments and powers on the involved side were lower at the knee and higher at the ankle and hip compared with the noninvolved side (Side by Joint P = 0.011; P = 0.003, respectively). The peak total extensor moment was not different between legs (P = 0.305) despite a decrease in knee moment and increases in ankle and hip moments (Side by Joint P = 0.015). During landing, knee motion was reduced (P = 0.043), and peak power absorbed was decreased at the knee and hip and increased at the ankle on the involved side compared to the noninvolved side (P = 0.003). The compensations by other joints may indicate protective adaptations to avoid overloading the reconstructed knee. PMID:20549185

  18. Construction of finite element model and stress analysis of anterior cruciate ligament tibial insertion

    PubMed Central

    Dai, Can; Yang, Liu; Guo, Lin; Wang, Fuyou; Gou, Jingyue; Deng, Zhilong

    2015-01-01

    Objective: The aim of the present study was to develop a more realistic finite element (FE) model of the human anterior cruciate ligament (ACL) tibial insertion and to analyze the stress distribution in the ACL internal fibers under load. Methods: The ACL tibial insertions were processed histologically. With Photoshop software, digital images taken from the histological slides were collaged, contour lines were drawn, and different gray values were filled based on the structure. The data were exported to Amira software and saved as “.hmascii” file. This document was imported into HyperMesh software. The solid mesh model generated using HyperMesh software was imported into Abaqus software. The material properties were introduced, boundary conditions were set, and load was added to carry out the FE analysis. Results: The stress distribution of the ACL internal fibers was uneven. The lowest stress could be observed in the ACL lateral fibers under tensile and shear load. Conclusion: The establishment of ACL tibial insertion FE model and mechanical analysis could reveal the stress distribution in the ACL internal fibers under load. There was greater load carrying capacity in the ACL lateral fibers which could sustain greater tensile and shear forces.

  19. Effect of Perturbing a Simulated Motion on Knee and Anterior Cruciate Ligament Kinetics

    PubMed Central

    Herfat, Safa T.; Boguszewski, Daniel V.; Nesbitt, Rebecca J.

    2013-01-01

    Current surgical treatments for common knee injuries do not restore the normal biomechanics. Among other factors, the abnormal biomechanics increases the susceptibility to the early onset of osteoarthritis. In pursuit of improving long term outcome, investigators must understand normal knee kinematics and corresponding joint and anterior cruciate ligament (ACL) kinetics during the activities of daily living. Our long term research goal is to measure in vivo joint motions for the ovine stifle model and later simulate these motions with a 6 degree of freedom (DOF) robot to measure the corresponding 3D kinetics of the knee and ACL-only joint. Unfortunately, the motion measurement and motion simulation technologies used for our project have associated errors. The objective of this study was to determine how motion measurement and motion recreation error affect knee and ACL-only joint kinetics by perturbing a simulated in vivo motion in each DOF and measuring the corresponding intact knee and ACL-only joint forces and moments. The normal starting position for the motion was perturbed in each degree of freedom by four levels (?0.50, ?0.25, 0.25, and 0.50 mm or degrees). Only translational perturbations significantly affected the intact knee and ACL-only joint kinetics. The compression-distraction perturbation had the largest effect on intact knee forces and the anterior-posterior perturbation had the largest effect on the ACL forces. Small translational perturbations can significantly alter intact knee and ACL-only joint forces. Thus, translational motion measurement errors must be reduced to provide a more accurate representation of the intact knee and ACL kinetics. To account for the remaining motion measurement and recreation errors, an envelope of forces and moments should be reported. These force and moment ranges will provide valuable functional tissue engineering parameters (FTEPs) that can be used to design more effective ACL treatments. PMID:23083204

  20. Radiographic findings in revision anterior cruciate ligament reconstructions from the Mars cohort.

    PubMed

    2013-08-01

    The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature. PMID:23404491

  1. Simulation of anterior cruciate ligament deficiency in a musculoskeletal model with anatomical knees.

    PubMed

    Guess, Trent M; Stylianou, Antonis

    2012-01-01

    Abnormal knee kinematics and meniscus injury resulting from anterior cruciate ligament (ACL) deficiency are often implicated in joint degeneration even though changes in tibio-femoral contact location after injury are small, typically only a few millimeters. Ligament reconstruction surgery does not significantly reduce the incidence of early onset osteoarthritis. Increased knowledge of knee contact mechanics would increase our understanding of the effects of ACL injury and help guide ACL reconstruction methods. Presented here is a cadaver specific computational knee model combined with a body-level musculoskeletal model from a subject of similar height and weight as the cadaver donor. The knee model was developed in the multi-body framework and includes representation of the menisci. Experimental body-level measurements provided input to the musculoskeletal model. The location of tibio-menisco-femoral contact as well as contact pressures were compared for models with an intact ACL, partial ACL transection (posterolateral bundle transection), and full ACL transection during a muscle driven forward dynamics simulation of a dual limb squat. During the squat, small changes in femur motion relative to the tibia for both partial and full ACL transection push the lateral meniscus in the posterior direction at extension. The central-anterior region of the lateral meniscus then becomes "wedged" between the tibia and femur during knee flexion. This "wedging" effect does not occur for the intact knee. Peak contact pressure and contact locations are similar for the partial tear and complete ACL transection during the deep flexion portion of the squat, particularly on the lateral side. The tibio-femoral contact location on the tibia plateau shifts slightly to the posterior and lateral direction with ACL transection. PMID:22470411

  2. Simulation of Anterior Cruciate Ligament Deficiency in a Musculoskeletal Model with Anatomical Knees

    PubMed Central

    Guess, Trent M; Stylianou, Antonis

    2012-01-01

    Abnormal knee kinematics and meniscus injury resulting from anterior cruciate ligament (ACL) deficiency are often implicated in joint degeneration even though changes in tibio-femoral contact location after injury are small, typically only a few millimeters. Ligament reconstruction surgery does not significantly reduce the incidence of early onset osteoarthritis. Increased knowledge of knee contact mechanics would increase our understanding of the effects of ACL injury and help guide ACL reconstruction methods. Presented here is a cadaver specific computational knee model combined with a body-level musculoskeletal model from a subject of similar height and weight as the cadaver donor. The knee model was developed in the multi-body framework and includes representation of the menisci. Experimental body-level measurements provided input to the musculoskeletal model. The location of tibio-menisco-femoral contact as well as contact pressures were compared for models with an intact ACL, partial ACL transection (posterolateral bundle transection), and full ACL transection during a muscle driven forward dynamics simulation of a dual limb squat. During the squat, small changes in femur motion relative to the tibia for both partial and full ACL transection push the lateral meniscus in the posterior direction at extension. The central-anterior region of the lateral meniscus then becomes “wedged” between the tibia and femur during knee flexion. This “wedging” effect does not occur for the intact knee. Peak contact pressure and contact locations are similar for the partial tear and complete ACL transection during the deep flexion portion of the squat, particularly on the lateral side. The tibio-femoral contact location on the tibia plateau shifts slightly to the posterior and lateral direction with ACL transection. PMID:22470411

  3. The forces in the anterior cruciate ligament and knee kinematics during a simulated pivot shift test: A human cadaveric study using robotic technology

    Microsoft Academic Search

    Akihiro Kanamori; Savio L. Y. Woo; C. Benjamin Ma; Jennifer Zeminski; Theodore W. Rudy; Guoan Li; Glen A. Livesay

    2000-01-01

    Purpose: Although it is well known that the anterior cruciate ligament (ACL) is a primary restraint of the knee under anterior tibial load, the role of the ACL in resisting internal tibial torque and the pivot shift test is controversial. The objective of this study was to determine the effect of these 2 external loading conditions on the kinematics of

  4. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement

    Microsoft Academic Search

    John C. Loh; Yukihisa Fukuda; Eiichi Tsuda; Richard J. Steadman; Freddie H. Fu; Savio L. Y. Woo

    2003-01-01

    Purpose: To study how well an anterior cruciate ligament (ACL) graft fixed at the 10 and 11 o'clock positions can restore knee function in response to both externally applied anterior tibial and combined rotatory loads by comparing the biomechanical results with each other and with the intact knee. Type of Study: Biomechanical experiment using human cadaveric specimens. Methods: Ten human

  5. Arthroscopic Repair of Anterior-Inferior Glenohumeral Instability Using a Portal at the 5:30-o’Clock PositionAnalysis of the Effects of Age, Fixation Method, and Concomitant Shoulder Injury on Surgical Outcomes

    Microsoft Academic Search

    Andreas B. Imhoff; Patrick Ansah; Thomas Tischer; Christoph Reiter; Christoph Bartl; Maximilian Hench; Jeffrey T. Spang; Stephan Vogt

    2010-01-01

    Background: Traumatic anterior-inferior shoulder joint dislocations are common injuries among the young athletic population. The aim of this study was to assess which factors, including concomitant injury (rotator cuff tears, superior labral anterior posterior [SLAP] lesions), patient age, and fixation methods, led to redislocation after arthroscopic stabilization.Hypothesis: There are several risk factors for the outcome after arthroscopic anterior-inferior glenohumeral stabilization.Study

  6. Jump-Landing Mechanics After Anterior Cruciate Ligament Reconstruction: A Landing Error Scoring System Study

    PubMed Central

    Bell, David Robert; Smith, Mason D.; Pennuto, Anthony P.; Stiffler, Mikel R.; Olson, Matthew E.

    2014-01-01

    Context: The Landing Error Scoring System (LESS) is a clinical evaluation of jump-landing mechanics and may provide useful information in assisting with return-to-sport decisions in patients after anterior cruciate ligament reconstruction (ACLR). However, it is currently unknown how patients with ACLR perform on the LESS compared with healthy controls. Objective: To determine if the total LESS score differed between individuals with ACLR and healthy controls and to determine the types of errors that differ between groups. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: A total of 27 individuals with unilateral ACLR (age = 19.8 ± 1.8 years, height = 170 ± 5.5 cm, mass = 68.8 ± 11.9 kg) and 27 controls (age = 20.5 ± 1.7 years, height = 169 ± 8.4 cm, mass = 66.6 ± 9.0 kg) with no history of ACLR. Intervention(s): Each participant completed 3 trials of a standardized jump-landing task. Main Outcome Measure(s): Each jump landing was assessed for specific postures using standardized LESS criteria by a blinded evaluator. Individual LESS items were summed to create a total LESS score. The dominant limb was assessed in the control group, and the reconstructed limb was assessed in the ACLR group. Results: The ACLR group had higher LESS scores compared with controls (ACLR: 6.7 ± 2.1 errors, control: 5.6 ± 1.5 errors, P = .04). Additionally, the ACLR group was more likely to err when landing with lateral trunk flexion (Fisher exact test, P = .002). Conclusions: Individuals with ACLR had worse landing mechanics as measured by the LESS. Lateral trunk deviation may be related to quadriceps avoidance in the reconstructed limb or poor trunk neuromuscular control. The LESS is useful for evaluating landing errors in patients with ACLR and may help to identify areas of focus during rehabilitation and before return to sport. PMID:24905666

  7. Anatomical anterior cruciate ligament reconstruction: transtibial versus outside-in technique

    PubMed Central

    MATASSI, FABRIZIO; SIRLEO, LUIGI; CARULLI, CHRISTIAN; INNOCENTI, MASSIMO

    2015-01-01

    Purpose the aim of this study was to compare clinical results and location of the femoral tunnel with transtibial (TT) and outside-in (OI) techniques in anterior cruciate ligament (ACL) reconstruction using in vivo 3D CT analysis. Methods we prospectively followed up 40 ACL reconstructions in which femoral tunnel placement was performed using two different techniques: TT [20] and OI [20]. Clinical evaluation was based on IKDC and KOOS scores and radiographic analysis with specific 3D CT scans. Tunnel coordinates were calculated using the Bernard-Hertel quadrant method to define the insertion point of the ACL. Results excellent clinical results were achieved in both groups, which showed comparable IKDC and KOOS scores. Two failures were recorded, both in the TT group. In the high-to-low direction, the position of the femoral tunnel, as measured using the quadrant method, was too high in the TT group, compared to what was observed in the OI group: 10.5 ± 6.9% (0–29%) and 30.2 ± 5.4% (19–42%), (p=0.043). Conclusions we found that with the TT technique, compared with the OI technique, the femoral tunnel was located higher in the high-to-low direction and was in a slightly shallower position in the deep-to-shallow direction. Using the OI technique the femoral tunnel was in a position closer to the anatomical ACL footprint than with the TT technique. A femoral tunnel position far from the anatomical footprint of the native ACL would result in a higher failure rate. Level of evidence level II, prospective comparative study. PMID:26151033

  8. Transcription factor Mohawk and the pathogenesis of human anterior cruciate ligament degradation

    PubMed Central

    Nakahara, Hiroyuki; Hasegawa, Akihiko; Otabe, Koji; Ayabe, Fumiaki; Matsukawa, Tetsuya; Onizuka, Naoko; Ito, Yoshiaki; Ozaki, Toshifumi; Lotz, Martin K.; Asahara, Hiroshi

    2013-01-01

    Objective To investigate the expression and function of Mohawk (MKX) in human adult anterior cruciate ligament (ACL) tissues and ligament cells from normal and osteoarthritis-affected knees. Methods Knee joints were obtained at autopsy within 24-48 hours postmortem from 13 normal donors (age 36.9±11.0 years), 16 OA donors (age 79.7±11.4 years) and 8 old donors without OA (age 76.9±12.9 years). All cartilage surfaces were graded macroscopically. MKX expression was analyzed by immunohistochemistry and quantitative PCR. ACL-derived cells were used to study regulation of MKX expression by IL-1?. MKX was knocked down by siRNA to analyze function of MKX in extracellular matrix (ECM) production and differentiation in ACL-derived cells. Results The expression of MKX was significantly decreased in ACL-derived cells from OA knees compared with normal knees. Consistent with this finding, immunohistochemistry showed that MKX positive cells were significantly reduced in ACL tissues from OA donors in particular in cells located in disorientated fibers. In ACL-derived cells, IL-1? strongly suppressed MKX gene expression and reduced ligament ECM genes, COL1A1 and TNXB. On the other hand, SOX9, chondrocyte master transcription factor, was up regulated by IL-1? treatment. Importantly, knock down of MKX expression by siRNA upregulated SOX9 expression in ACL-derived cells, whereas the expression of COL1A1 and TNXB were decreased. Conclusion Reduced expression of MKX is a feature of degenerated ACL in OA-affected joints and this may be in part mediated by IL-1?. MKX appears necessary to maintain the tissue specific cellular differentiation status and ECM production in adult human tendons and ligaments. PMID:23686683

  9. Neuromuscular function after reconstruction of anterior cruciate ligament--a case study using evoked electromyography.

    PubMed

    Daikuya, S; Suzuki, T; Yabe, K

    2008-01-01

    To clarify the neuro-muscular function of a lower extremity after reconstruction of anterior cruciate ligament (ACL), we studied the alteration of H reflex and Silent period (SP) from the soleus muscle in a patient with ACL reconstruction. Subject was an eighteen year-old male and high school basketball player after a reconstruction of right ACL. Recording of H reflex and SP was started at one month after operation, and ended at six months post operation with a test at every month. As a result of this study, the amplitude ratio of H/M(max) was increased at post four months after ACL reconstruction on operative side. Little variation of SP was acquired in non-operative side. However, that in operative side was increased compared with non-operative side and gradually decreased until post six months. Post six months, the variation of SP in operative side was recovered as that of non-operative side. And, on the operation side, long-latency reflex (LLR) was appeared during SP from one month to five months after, especially its appearance pattern was most markedly post four months. However, post six months, LLR disappeared during SP. The result of H reflex, SP and LLR appearance suggested a following hypothesis; until post six months after ACL reconstruction, even the small and simple task (i.e. an ankle planter flexion with a slight effort) needs to an intervention of a various supra-spinal function. In this case, autonomy of central nervous system related to an out-put mechanism in lower-extremity was acquired post six months. PMID:18551833

  10. Knee moments of anterior cruciate ligament reconstructed and control participants during normal and inclined walking

    PubMed Central

    Varma, Raghav K; Duffell, Lynsey D; Nathwani, Dinesh; McGregor, Alison H

    2014-01-01

    Objectives Prior injury to the knee, particularly anterior cruciate ligament (ACL) injury, is known to predispose one to premature osteoarthritis (OA). The study sought to explore if there was a biomechanical rationale for this process by investigating changes in external knee moments between people with a history of ACL injury and uninjured participants during walking: (1) on different surface inclines and (2) at different speeds. In addition we assessed functional differences between the groups. Participants 12 participants who had undergone ACL reconstruction (ACLR) and 12 volunteers with no history of knee trauma or injury were recruited into this study. Peak knee flexion and adduction moments were assessed during flat (normal and slow speed), uphill and downhill walking using an inclined walkway with an embedded Kistler Force plate, and a ten-camera Vicon motion capture system. Knee injury and Osteoarthritis Outcome Score (KOOS) was used to assess function. Multivariate analysis of variance (MANOVA) was used to examine statistical differences in gait and KOOS outcomes. Results No significant difference was observed in the peak knee adduction moment between ACLR and control participants, however, in further analysis, MANOVA revealed that ACLR participants with an additional meniscal tear or collateral ligament damage (7 participants) had a significantly higher adduction moment (0.33±0.12?Nm/kg?m) when compared with those with isolated ACLR (5 participants, 0.1±0.057?Nm/kg?m) during gait at their normal speed (p<0.05). A similar (non-significant) trend was seen during slow, uphill and downhill gait. Conclusions Participants with an isolated ACLR had a reduced adductor moment rather an increased moment, thus questioning prior theories on OA development. In contrast, those participants who had sustained associated trauma to other key knee structures were observed to have an increased adduction moment. Additional injury concurrent with an ACL rupture may lead to a higher predisposition to osteoarthritis than isolated ACL deficiency alone. PMID:24898088

  11. Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors

    PubMed Central

    Seijas, Roberto; Ares, Oscar; Cuscó, Xavier; Álvarez, Pedro; Steinbacher, Gilbert; Cugat, Ramón

    2014-01-01

    AIM: To evaluate the effect of the application of plasma rich in growth factors (PRGF)-Endoret to the remaining intact bundle in partial anterior cruciate ligament (ACL) tears. METHODS: A retrospective review of the rate of return to play in football players treated with the application of PRGF-Endoret in the remaining intact bundle in partial ACL injuries that underwent surgery for knee instability. Patients with knee instability requiring revision surgery for remnant ACL were selected. PRGF was applied in the wider part of posterolateral bundle and the time it took patients to return to their full sporting activities at the same level before the injury was evaluated. RESULTS: A total of 19 patients were reviewed. Three had a Tegner activity level of 10 and the remaining 16 level 9. The time between the injury and the time of surgery was 5.78 wk (SD 1.57). In total, 81.75% (16/19) returned to the same pre-injury level of sport activity (Tegner 9-10). 17 males and 2 females were treated. The rate of associated injury was 68.42% meniscal lesions and 26.31% cartilage lesions. The KT-1000 values were normalized in all operated cases. One patient was not able to return to sport due to the extent of their cartilage lesions. The 15 patients with Tegner activity level 9 returned to play at an average of 16.20 wk (SD 1.44) while the 3 patients with Tegner activity level 10 did so in 12.33 wk (SD 1.11). CONCLUSION: With one remaining intact bundle the application of PRGF-Endoret in instability cases due to partial ACL tear showed high return to sport rates at pre- injury level in professional football players. PMID:25035842

  12. Partial tears of anterior cruciate ligament: Results of single bundle augmentation

    PubMed Central

    Sabat, Dhananjaya; Kumar, Vinod

    2015-01-01

    Background: Partial tears of the anterior cruciate ligament (ACL) are common and usually present with symptomatic instability. The remnant fibers are usually removed and a traditional ACL reconstruction is done. But with increased understanding of ACL double bundle anatomy, the remnant tissue preservation along with a single bundle augmentation of the torn bundle is also suggested. The purpose of this study was to evaluate the results of selective anatomic augmentation of symptomatic partial ACL tears. Our hypothesis is that this selective augmentation of partial ACL tears could restore knee stability and function. Materials and Methods: Consecutive cases of 314 ACL reconstructions, 40 patients had intact ACL fibers in the location corresponding to the anteromedial (AM) or posterolateral (PL) bundle and were diagnosed as partial ACL tears perioperatively. All patients underwent selective augmentation of the torn bundle, while keeping the remaining fibers intact using autogenous hamstring graft. A total of 38 patients (28 males, 10 females) were available with a minimum of 3 years followup. 26 cases had AM bundle tears and 12 cases had PL bundle tears respectively. Patients were assessed with International Knee Documentation Committee (IKDC) 2000 Knee Evaluation Form, Lysholm score; instrumented knee testing was performed with the arthrometer (KT 2000). Statistical analysis was performed to compare the preoperative and postoperative objective evaluation. Results: At 3 years followup, 31.6% patients were graded A, 65.8% were graded B and 2.6% was graded C at IKDC objective evaluation. Manual laxity tests, Lysholm's score, mean side to side instrumental laxity and Tegner activity score improved significantly. 76% patients returned to preinjury level of sports activity after augmentation. Conclusion: The results of anatomic single bundle augmentation in partial ACL tears are encouraging with excellent improvement in functional scores, side to side laxity and return to sports activity. PMID:26015599

  13. Proprioceptive sensitivity and performance in anterior cruciate ligament-deficient knee joints.

    PubMed

    Fischer-Rasmussen, T; Jensen, P E

    2000-04-01

    We studied the performance and proprioception of the knee joint in a group of non-reconstructed anterior cruciate ligament (ACL)-deficient (n=20) patients and compared them with a group of ACL-reconstructed patients (n=18) and a group of healthy controls (n=20). Each patient was scored according to Lysholm and Tegner and was then asked to subjectively evaluate the performance of the injured knee and the degree of retropatellar discomfort. The knee joint laxity was measured. The performance was assessed based on the performance in a triple jump test and a one-leg one-step leap test. The proprioception in the knee was measured as the threshold when passive movement was detected and as the ability to reproduce a flexion angle from a start position of 60 degrees of flexion or from full extension of the knee. All tests were performed on both legs. The scoring systems and the subjective evaluation showed significant differences between the reconstructed and the non-reconstructed patients. No significant difference in knee joint laxity was found between the two groups. In the triple jump test and the one-step leap test, both groups performed significantly worse on the leg with the injured knee joint than on the non-injured leg. The proprioceptive tests showed decreased ability to recognize and reproduce a prior angle from a start position of 60 degrees. The threshold to detection of passive movement with the injured knee was significantly increased in both groups of patients. No difference was found between the dominant and non-dominant knee in the control group. When reproduction of the same angles started from full extension, the groups did not differ. These data show that decreased performance and changes in the proprioception of the knee joint accompany ACL rupture. PMID:10755278

  14. Pilot study of female high school basketball players' anterior cruciate ligament injury knowledge, attitudes, and practices.

    PubMed

    Iversen, M D; Friden, C

    2009-08-01

    An anterior cruciate ligament (ACL) injury prevention program was evaluated. One hundred and thirteen female high school varsity and junior varsity basketball players and 12 coaches participated in an 8-week educational and skills program. Demographic and injury history data were collected. At pre-intervention and at the end of season, knowledge, attitudes, and practices about ACL risk and injury prevention were assessed via questionnaires, and frequency of two-footed landings were videotaped during games. Univariate statistics described the sample. Paired t-tests evaluated the program's impact. Cronbach's alpha, correlations, and kappa statistics assessed the validity and reliability of questionnaires and video analysis. Of the 113 players, 74 completed the study. The players' mean age was 16.25 years (SD=1.07; range=14.2-18.8). Baseline knowledge score was 57.2%, practice 58.4%, and attitude 73.5%. The mean baseline knowledge score of the 12 coaches (mean age=40.8 years; SD=10.3; range=26.9-56.3) was 68.7%. Players' knowledge about ACL injury prevention improved (t=2.57; P<0.01). No changes in attitudes toward injury prevention were found (t(diff)=1.88; P<0.06). Inter-rater reliability of two-footed landings observed was acceptable (kappa=0.72). Videotape analyses revealed a 5.5% increase in landing performance (t(diff)=9.6; P<0.0001). The program increased knowledge about ACL injury risk and improved player's landing skills. PMID:18627558

  15. Prevention and Screening Programs for Anterior Cruciate Ligament Injuries in Young Athletes

    PubMed Central

    Swart, Eric; Redler, Lauren; Fabricant, Peter D.; Mandelbaum, Bert R.; Ahmad, Christopher S.; Wang, Y. Claire

    2014-01-01

    Background: Anterior cruciate ligament (ACL) injuries are common among young athletes. Biomechanical studies have led to the development of training programs to improve neuromuscular control and reduce ACL injury rates as well as screening tools to identify athletes at higher risk for ACL injury. The purpose of this study was to evaluate the cost-effectiveness of these training methods and screening strategies for preventing ACL injuries. Methods: A decision-analysis model was created to evaluate three strategies for a population of young athletes participating in organized sports: (1) no training or screening, (2) universal neuromuscular training, and (3) universal screening, with neuromuscular training for identified high-risk athletes only. Risk of injury, risk reduction from training, and sensitivity and specificity of screening were based on published data from clinical trials. Costs of training and screening programs were estimated on the basis of the literature. Sensitivity analyses were performed on key model parameters to evaluate their effect on base case conclusions. Results: Universal neuromuscular training of all athletes was the dominant strategy, with better outcomes and lower costs compared with screening. On average, the implementation of a universal training program would save $100 per player per season, and would reduce the incidence of ACL injury from 3% to 1.1% per season. Screening was not cost-effective within the range of reported sensitivity and specificity values. Conclusions and Clinical Relevance: Given its low cost and ease of implementation, neuromuscular training of all young athletes represents a cost-effective strategy for reducing costs and morbidity from ACL injuries. While continued innovations on inexpensive and accurate screening methods to identify high-risk athletes remain of interest, improving existing training protocols and implementing neuromuscular training into routine training for all young athletes is warranted. PMID:24806006

  16. Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function.

    PubMed

    Tengman, E; Brax Olofsson, L; Nilsson, K G; Tegner, Y; Lundgren, L; Häger, C K

    2014-12-01

    Little is known about physical activity level and knee function including jump capacity and fear of movement/reinjury more than 20 years after injury of the anterior cruciate ligament (ACL). Seventy persons with unilateral ACL injury participated (23?±?2 years post-injury): 33 treated with physiotherapy in combination with surgical reconstruction (ACLR ), and 37 treated with physiotherapy alone (ACLPT ). These were compared with 33 age- and gender-matched controls. Assessment included knee-specific and general physical activity level [Tegner activity scale, International Physical Activity Questionnaire (IPAQ)], knee function [Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS)], jump capacity (one-leg hop, vertical jump, side hops), and fear of movement/reinjury [Tampa Scale for Kinesiophobia (TSK)]. Outcomes were related to degree of osteoarthritis (OA). ACL-injured had lower Lysholm, KOOS, and Tegner scores than controls (P?

  17. Proteomic Differences between Male and Female Anterior Cruciate Ligament and Patellar Tendon

    PubMed Central

    Little, Dianne; Thompson, J. Will; Dubois, Laura G.; Ruch, David S.; Moseley, M. Arthur; Guilak, Farshid

    2014-01-01

    The risk of anterior cruciate ligament (ACL) injury and re-injury is greater for women than men. Among other factors, compositional differences may play a role in this differential risk. Patellar tendon (PT) autografts are commonly used during reconstruction. The aim of the study was to compare protein expression in male and female ACL and PT. We hypothesized that there would be differences in key structural components between PT and ACL, and that components of the proteome critical for response to mechanical loading and response to injury would demonstrate significant differences between male and female. Two-dimensional liquid chromatography-tandem mass spectrometry and a label-free quantitative approach was used to identify proteomic differences between male and female PT and ACL. ACL contained less type I and more type III collagen than PT. There were tissue-specific differences in expression of proteoglycans, and ACL was enriched in elastin, tenascin C and X, cartilage oligomeric matrix protein, thrombospondin 4 and periostin. Between male and female donors, alcohol dehydrogenase 1B and complement component 9 were enriched in female compared to male. Myocilin was the major protein enriched in males compared to females. Important compositional differences between PT and ACL were identified, and we identified differences in pathways related to extracellular matrix regulation, complement, apoptosis, metabolism of advanced glycation end-products and response to mechanical loading between males and females. Identification of proteomic differences between male and female PT and ACL has identified novel pathways which may lead to improved understanding of differential ACL injury and re-injury risk between males and females. PMID:24818782

  18. In vitro characterization of self-assembled anterior cruciate ligament cell spheroids for ligament tissue engineering.

    PubMed

    Hoyer, M; Meier, C; Breier, A; Hahner, J; Heinrich, G; Drechsel, N; Meyer, M; Rentsch, C; Garbe, L-A; Ertel, W; Lohan, A; Schulze-Tanzil, G

    2015-03-01

    Tissue engineering of an anterior cruciate ligament (ACL) implant with functional enthesis requires site-directed seeding of different cell types on the same scaffold. Therefore, we studied the suitability of self-assembled three-dimensional spheroids generated by lapine ACL ligament fibroblasts for directed scaffold colonization. The spheroids were characterized in vitro during 14 days in static and 7 days in dynamic culture. Size maintenance of self-assembled spheroids, the vitality, the morphology and the expression pattern of the cells were monitored. Additionally, we analyzed the total sulfated glycosaminoglycan, collagen contents and the expression of the ligament components type I collagen, decorin and tenascin C on protein and for COL1A1, DCN and TNMD on gene level in the spheroids. Subsequently, the cell colonization of polylactide-co-caprolactone [P(LA-CL)] and polydioxanone (PDS) polymer scaffolds was assessed in response to a directed, spheroid-based seeding technique. ACL cells were able to self-assemble spheroids and survive over 14 days. The spheroids decreased in size but not in cellularity depending on the culture time and maintained or even increased their differentiation state. The area of P[LA-CL] scaffolds, colonized after 14 days by the cells of one spheroid, was in average 4.57 ± 2.3 mm(2). Scaffolds consisting of the polymer P[LA-CL] were more suitable for colonization by spheroids than PDS embroideries. We conclude that ACL cell spheroids are suitable as site-directed seeding strategy for scaffolds in ACL tissue engineering approaches and recommend the use of freshly assembled spheroids for scaffold colonization, due to their balanced proliferation and differentiation. PMID:25256666

  19. The effect of blocking angiogenesis on anterior cruciate ligament healing following stem cell transplantation.

    PubMed

    Takayama, Koji; Kawakami, Yohei; Mifune, Yutaka; Matsumoto, Tomoyuki; Tang, Ying; Cummins, James H; Greco, Nick; Kuroda, Ryosuke; Kurosaka, Masahiro; Wang, Bing; Fu, Freddie H; Huard, Johnny

    2015-08-01

    Ruptured human anterior cruciate ligaments (ACL) contain vascular stem cells capable of enhancing the healing of tendon grafts. In the current study we explored the role that neo-angiogenesis plays in ACL healing. ACL-derived CD34+ cells were isolated via Fluorescence Activated Cell Sorting (FACS) from the rupture sites of human ACLs. The cells were then virally transduced to express either vascular endothelial growth factor (VEGF) or soluble FLT-1 (sFLT-1), which is an antagonist of VEGF. We established five groups: CD34+VEGF(100%), where 100% of the cells were transduced with VEGF, CD34+VEGF(25%), where only 25% of the cells were transduced with VEGF, CD34+, CD34+sFLT-1, and a No cells group. The CD34+sFLT1 group had a significant reduction in biomechanical strength compared to the CD34+ group at 4 and 8 weeks; whereas the biomechanical strength of the CD34+VEGF(25%) group was significantly greater than the CD34+ group at week 4; however, no difference was observed by week 8. Immunohistochemical staining demonstrated a significantly lower number of isolectin B4 and hCD31 positive cells, markers associated with angiogenesis, in the CD34+sFLT1 group, and a higher number of isolectin B4 and hCD31 positive cells in the CD34+VEGF(100%) and CD34+VEGF(25%) groups compared to the CD34+ group. Graft maturation was significantly delayed in the CD34+sFLT1 group and accelerated in the CD34+VEGF(25%) group compared to the CD34+ group. In conclusion, blocking VEGF reduced angiogenesis, graft maturation and biomechanical strength following ACL reconstruction. Native expression of VEGF by the CD34+ cells improved tendon graft maturation and biomechanical strength; however, over-expression of VEGF impeded improvements in biomechanical strength. PMID:25965282

  20. Pre-operative quadriceps strength predicts IKDC2000 scores 6 months after anterior cruciate ligament reconstruction

    PubMed Central

    Logerstedt, David; Lynch, Andrew; Axe, Michael J.; Snyder-Mackler, Lynn

    2012-01-01

    Background Quadriceps strength deficits are ubiquitous after anterior cruciate ligament (ACL) injury. Deficits prior to surgery can influence knee function post-operatively. Inhibition contributes to quadriceps strength deficits after an ACL injury. Body mass index, meniscal injury, and sex influence functional outcomes after ACL reconstruction. The purpose of this study is to examine the relationship of pre-operative quadriceps strength and post-operative knee function and to investigate how other pre-operative factors may influence this relationship. Methods After an ACL injury, subjects received pre-operative rehabilitation and performed quadriceps strength testing. Subjects underwent reconstruction and post-operative rehabilitation. Six months after ACL reconstruction, subjects completed the International Knee Documentation Committee 2000 subjective form (IKDC2000). Linear regression models were developed using IKDC2000 scores at 6 months after ACL reconstruction as the dependent variable. Results Fifty-five subjects had complete pre-operative data and IKDC2000 scores at 6 months after ACL reconstruction. Pre-operative involved quadriceps strength was a significant predictor for IKDC2000 scores 6 months after ACL reconstruction. Sex, meniscal injury, pre-operative BMI, and pre-operative involved quadriceps activation ratio were not significant predictors in the regression model. Conclusions Pre-operative quadriceps strength can predict IKDC2000 scores 6 months after ACL reconstruction. Deficits in pre-operative quadriceps strength influence self-reported function 6 months after surgery. Factors that are known to influence quadriceps strength and self-reported outcomes do not influence the relationship between pre-operative quadriceps strength and post-operative IKDC2000 scores. PMID:23022031

  1. Reactive Neuromuscular Training for the Anterior Cruciate Ligament-Deficient Knee: A Case Report

    PubMed Central

    Cook, Gray; Burton, Lee; Fields, Keith

    1999-01-01

    Objective: To demonstrate the response to a proprioceptive training model during a 1-week rehabilitation regime. The techniques were demonstrated on a college-aged female basketball player who had injured her anterior cruciate ligament (ACL) several weeks earlier. The athlete was tested, trained, and then retested during her semester break. Background: The ACL injury has become a fairly common occurrence in the world of athletics. Knowing this, the athletic trainer is constantly searching for ways to improve the rehabilitative process. New research demonstrates that rehabilitation should be based on proprioception. The ACL not only serves a mechanical role by limiting passive knee mobility but also serves a sensory role through the mechanoreceptors deep in its tissue, which communicate with the neuromuscular system to provide proprioceptive feedback during training and competition. Differential Diagnosis: Partial or complete tear of the ACL. Treatment: The athlete was treated with a rehabilitation protocol based on proprioception, which uses reactive neuromuscular training. Uniqueness: Our rehabilitation focused on the muscular imbalances about the hip, knee, and ankle. The athlete achieved dramatic decreases in muscular imbalances about the hip and knee in only 1 week of rehabilitation through reactive neuromuscular training. Conclusions: The athlete had significant gains in strength over her brief period of therapy. However, these gains can be viewed only as neuromuscular changes and not strictly as gains in strength. The athlete returned to postseason competition under the supervision of her surgeon, who later recommended surgical reconstruction at the completion of the basketball season with rehabilitation during the offseason. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10.Figure 11.Figure 12. PMID:16558562

  2. A phenomenological contact model: Understanding the graft-tunnel interaction in anterior cruciate ligament reconstructive surgery.

    PubMed

    Salehghaffari, Shahab; Dhaher, Yasin Y

    2015-07-16

    In this paper, we sought to expand the fidelity of a validated model of the anterior cruciate ligament reconstruction (ACL-R) procedure by incorporating a stick-slip contact model with linear pressure-overclosure relationship at the interface. The suggested model is characterized by three unknown parameters, friction coefficient, shear stress softening and contact stiffness. In the absence of any isolated experiments exploring the graft-tunnel interactions during an aggregate joint load, the calibration data used in this study are derived from a reported biomechanical study. A Bayesian calibration procedure was employed to find the unknown probability distribution function (PDF) of these contact parameters. Initially, the response surface approximations of the predicted graft forces from laxity test simulations was adopted to estimate the likelihood of noisy experimental data reported in the literature. Then, the wide domain of contact parameters was sampled sequentially based on the Marcov Chain Monte Carlo (MCMC) method with acceptance-rejection criteria to search for population of samples in significantly narrower domain of unknown parameters that are associated with the highest occurrence likelihood of noisy experimental data. Our simulations with calibrated contact parameters indicate that pre-tensioning applied at 30° of flexion leads to larger graft force after the joint is fully extended compared to the graft force when the same pre-tensioning force is applied at full extension. Moreover, regardless of the pre-tensioning force, the graft-tunnel contact pressure is larger when the fixation of the graft is performed at full extension, increasing with the pre-tensioning force. PMID:26100464

  3. Metrecom Measurement of Navicular Drop in Subjects with Anterior Cruciate Ligament Injury

    PubMed Central

    Allen, Mary K.; Glasoe, Ward M.

    2000-01-01

    Objective: Research suggests that excessive pronation of the foot contributes to the incidence of anterior cruciate ligament (ACL) tears by increasing internal tibial rotation. Studies have documented greater navicular drop values in individuals with a history of an ACL tear using methods that may not accurately follow the motion of underlying bone. The purpose of our investigation was to compare the navicular drop of subjects with a history of ACL tears with healthy controls when measured by a Metrecom. Subjects: Eighteen subjects previously diagnosed with a torn ACL were matched by age, sex, and limb to noninjured control subjects. Design and Setting: Static group comparisons of navicular drop in subjects with an injured ACL and subjects having no history of ACL injury. Measurements: A single investigator performed the measure of navicular drop. The position of the navicular tuberosity was digitized while the subject stood barefoot on a flat surface in subtalar joint neutral and in relaxed stance. Intrarater reliability was assessed using intraclass correlation coefficient and standard error of the measurement. An independent t test assessed the difference between the amount of navicular drop in the ACL group and the controls. Results: Analysis of repeated measures, intraclass correlation coefficient (2,1), demonstrated intrarater reliability for the measure of navicular drop to be 0.90; the standard error of measurement was 1.19 mm. The independent t test showed a statistically greater amount of navicular drop in the ACL group. Conclusions: Excellent intrarater reliability was demonstrated when using the Metrecom to measure navicular drop. Excessive subtalar joint pronation, measured as navicular drop, was identified as 1 factor that may contribute to ACL injury. ImagesFigure 1.Figure 2. PMID:16558652

  4. Role of Hyperpronation as a Possible Risk Factor for Anterior Cruciate Ligament Injuries

    PubMed Central

    Smith, Joanne; Szczerba, Joe E.; Arnold, Brent L.; Perrin, David H.; Martin, David E.

    1997-01-01

    Objective: The purpose of this study was to examine the relationship between hyperpronation and the occurrence of noncontact injury to the anterior cruciate ligament (ACL). Design and Setting: Subjects were categorized as either ACL injured (ACLI) or ACL uninjured (ACLU). All ACLI subjects received their injuries from a noncontact mechanism. To justify using the ACLI subjects' uninjured legs as representative of their preinjury state, a t test was used to compare the differences between the left and right foot for the ACLU group on both measurements. Based on the results of the t test, a regression analysis was performed to determine whether group membership could be predicted from navicular drop. All measures were performed in a university athletic training room. Subjects: Fourteen ACLI subjects (age = 21.07 ± 0.83 yr, ht = 174.81±8.29 cm, wt = 72.32±13.47 kg) and 14 ACLU subjects (age = 21.14±2.03 yr, ht = 177.35±11.31 cm, wt = 72.99±14.81 kg) participated. Measurements: Hyperpronation was assessed via the navicular drop test and the calcaneal stance test. Results: No significant difference (p > .05) between feet for the navicular drop test was found. However, there was a significant difference (p < .05) between feet for the calcaneal stance test, and, thus, this measure was not used in the regression analysis. Using the navicular drop score, the regression analysis was unable to predict group membership. Conclusions: Hyperpronation as measured by the navicular drop test was not a predictor of ACL injury, and, thus, may not be a predisposing factor to noncontact ACL injuries. ImagesFig 1.Fig 2. PMID:16558428

  5. Postural stability does not differ among female sports with high risk of anterior cruciate ligament injury.

    PubMed

    Cortes, Nelson; Porter, Larissa D; Ambegaonkar, Jatin P; Caswell, Shane V

    2014-12-01

    Dancers have a lower incidence of anterior cruciate ligament (ACL) injury compared to athletes in sports that involve cutting and landing motions. Balance can impact ACL injury risk and is related to neuromuscular control during movement. The purpose of this study was to investigate whether balance differences exist among female dancers and female soccer and basketball athletes. Fifty-eight female dancers, soccer, and basketball athletes (16.5 ± 1.6 yrs, 1.6 ± 0.2 m, 60.2 ± 14.1 kg) completed the Stability Evaluation Test (SET) on the NeuroCom VSR Sport (NeuroCom International, Clackamas, OR) to measure sway velocity. Video records of the SET test were used for Balance Error Scoring System (BESS) test scoring. A oneway ANCOVA compared composite sway velocity and BESS scores among sports. There was no statistically significant difference for sway velocity or BESS among sports (sway velocity soccer 2.3 ± 0.4, dance 2.2 ± 0.4, and basketball 2.4 ± 0.4; BESS soccer 13.6 ± 5.0, dance 11.9 ± 5.5, and basketball 14.9 ± 5.1, p>0.05). Balance was similar among athletes participating in different sports (dance, basketball, and soccer). Quasi-static balance may not play a significant role in neuromuscular control during movement and not be a significant risk factor to explain the disparity in ACL injury incidence among sports. Future research should examine the effects of dynamic balance and limb asymmetries among sports to elucidate on the existing differences on ACL injury incidence rates. PMID:25433258

  6. Revision anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft and extra-articular iliotibial band tenodesis.

    PubMed

    Mascarenhas, Randy; McConkey, Mark O; Forsythe, Brian; Harner, Christopher D

    2015-04-01

    Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure with outcomes that generally fail to reach those seen with primary ACL reconstruction. With most index procedures using autograft tissue, it is not uncommon for allograft tissue to be required for revision ACL reconstruction. Compared with autografts, allografts take longer to incorporate and lead to more episodes of instability. In this article, we describe ipsilateral iliotibial band tenodesis performed to augment use of bone-patellar tendon-bone allograft in revision ACL reconstruction. This technique adds rotational stability to protect the allograft tissue while it incorporates. PMID:25844596

  7. Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long-term follow-up

    Microsoft Academic Search

    Eva Möller; Lars Weidenhielm; Suzanne Werner

    2009-01-01

    The aim of the present investigation was to study patient-reported long-term outcome after anterior cruciate ligament (ACL)\\u000a reconstruction. On an average 11.5 years after ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft 56 patients\\u000a were asked to answer four different questionnaires about their knee function and knee-related quality of life. Another aim\\u000a was to study whether there were any correlations between clinical

  8. A tissue engineering approach to anterior cruciate ligament regeneration using novel shaped capillary channel polymer fibers

    NASA Astrophysics Data System (ADS)

    Sinclair, Kristofer D.

    2009-12-01

    Ruptures of the anterior cruciate ligament (ACL) are the most frequent of injuries to the knee due to its role in preventing anterior translation of the tibia. It is estimated that as many as 200,000 Americans per year will suffer from a ruptured ACL, resulting in management costs on the order of 5 billion dollars. Without treatment these patients are unable to return to normal activity, as a consequence of the joint instability found within the ACL deficient knee. Over the last thirty years, a variety of non-degradable, synthetic fibers have been evaluated for their use in ACL reconstruction; however, a widely accepted prosthesis has been unattainable due to differences in mechanical properties of the synthetic graft relative to the native tissue. Tissue engineering is an interdisciplinary field charged with the task of developing therapeutic solutions for tissue and organ failure by enhancing the natural wound healing process through the use of cellular transplants, biomaterials, and the delivery of bioactive molecules. The capillary channel polymer (CC-P) fibers used in this research were fabricated by melt extrusion from polyethylene terephthalate and polybutylene terephthalate. These fibers possess aligned micrometer scale surface channels that may serve as physical templates for tissue growth and regeneration. This inherent surface topography offers a unique and industrially viable approach for cellular contact guidance on three dimensional constructs. In this fundamental research the ability of these fiber channels to support the adhesion, alignment, and organization of fibroblasts was demonstrated and found to be superior to round fiber controls. The results demonstrated greater uniformity of seeding and accelerated formation of multi-layered three-dimensional biomass for the CC-P fibers relative to those with a circular cross-section. Furthermore, the CC-P geometry induced nuclear elongation consistent with that observed in native ACL tissue. Through the application of uniaxial cyclic strain the mechanical properties of the cell seeded CC-P fiber scaffold systems were shown to improve via the induction of increased cellular proliferation and extracellular matrix synthesis. Finally, unlike many studies examining the effects of cyclic strain on cellular behavior, the CC-P fiber geometry displayed the ability to maintain cellular alignment in the presence of an applied uniaxial cyclic strain.

  9. Double-bundle posterior cruciate ligament reconstruction with quadriceps and semitendinosus tendon grafts

    Microsoft Academic Search

    Chih-Hwa Chen; Wen-Jer Chen; Chun-Hsiung Shih

    2003-01-01

    This study presents a novel arthroscopic technique for double-bundle reconstruction of the posterior cruciate ligament. A quadriceps tendon-patellar bone autograft is used to reconstruct the major anterolateral bundle. An additional double-stranded semitendinosus tendon is used to reconstruct the posteromedial bundle. In 70° of flexion and full extension with anterior drawer force, the quadriceps tendon graft and semitendinosus tendon graft are

  10. Pediatric Anterior Cruciate Ligament Femoral Fixation: The Trans-Iliotibial Band Endoscopic Portal for Direct Visualization of Ideal Button Placement

    PubMed Central

    Mistovich, R. Justin; O'Toole, Patrick O.J.; Ganley, Theodore J.

    2014-01-01

    Pediatric and adolescent anterior cruciate ligament reconstruction is a commonly performed procedure that has been increasing in incidence. Multiple techniques for graft fixation have been described. Button-based femoral cortical suspension fixation of the anterior cruciate ligament graft allows for fast, secure fixation with strong load-to-failure biomechanical properties. The biomechanical properties of button-based femoral cortical suspension fixation are especially beneficial with soft-tissue grafts such as hamstring autografts. Confirmation of a successfully flipped button can be achieved with intraoperative fluoroscopy or indirect viewing; however, these techniques do not provide direct visualization of the flipped button. Our trans-iliotibial band endoscopic portal allows the surgeon to safely and directly visualize the flipped button on the lateral femoral cortex and ensure that there is no malpositioning in the form of an incompletely flipped button or from soft-tissue interposition between the button and the lateral femoral cortex. This portal therefore allows for direct visual confirmation that the button is fully flipped and resting flush against the femoral cortex, deep to the iliotibial band and vastus lateralis. PMID:25126498

  11. Avoiding Graft-Tunnel Length Mismatch in Anterior Cruciate Ligament Reconstruction: The Single–Bone Plug Technique

    PubMed Central

    Grawe, Brian; Smerina, Amber; Allen, Answorth

    2014-01-01

    Anterior cruciate ligament reconstruction, using autogenous bone–patellar tendon–bone (BTB) as a graft material, is commonly performed in the setting of anterior cruciate ligament insufficiency. Although bone–patellar tendon–bone autograft has an extensive track record, showing excellent clinical results, donor-site morbidity and graft-tunnel mismatch can still be problematic for a subset of patients. In the setting of a tendon graft that is too long, adequate interference screw fixation cannot be obtained, typically resulting in a tibial-sided bone plug that achieves less than 15 to 20 mm of bone in the distal tibial tunnel. We present an easy and effective technique for avoiding the graft-tunnel mismatch problems that commonly occur in patients who have an excessively long patellar tendons. This technique involves a simple preoperative planning algorithm that ultimately results in a single tibial-sided plug harvest. Bony interference fixation is then obtained on the femoral side and soft-tissue fixation on the tibial side. This technique allows for satisfactory graft fixation while avoiding the donor-site morbidity associated with patellar bone plug harvest. PMID:25126515

  12. Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction.

    PubMed

    Hewett, Timothy E; Di Stasi, Stephanie L; Myer, Gregory D

    2013-01-01

    Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will go on to a second knee injury. The outcomes after a second knee injury and surgery are significantly less favorable than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques have improved to consistently restore passive joint stability to the preinjury level, successful return to sport after ACLR appears to be predicated on numerous postsurgical factors. Importantly, a secondary ACL injury is most strongly related to modifiable postsurgical risk factors. Biomechanical abnormalities and movement asymmetries, which are more prevalent in this cohort than previously hypothesized, can persist despite high levels of functional performance, and also represent biomechanical and neuromuscular control deficits and imbalances that are strongly associated with secondary injury incidence. Decreased neuromuscular control and high-risk movement biomechanics, which appear to be heavily influenced by abnormal trunk and lower extremity movement patterns, not only predict first knee injury risk but also reinjury risk. These seminal findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. Evidence-based medicine (EBM) strategies should be used to develop effective, efficacious interventions targeted to these impairments to optimize the safe return to high-risk activity. In this Current Concepts article, the authors present the latest evidence related to risk factors associated with ligament failure or a secondary (contralateral) injury in athletes who return to sport after ACLR. From these data, they propose an EBM paradigm shift in postoperative rehabilitation and return-to-sport training after ACLR that is focused on the resolution of neuromuscular deficits that commonly persist after surgical reconstruction and standard rehabilitation of athletes. PMID:23041233

  13. Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Hewett, Timothy E.; Di Stasi, Stephanie L.; Myer, Gregory D.

    2013-01-01

    Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will go on to a second knee injury. The outcomes after a second knee injury and surgery are significantly less favorable than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques have improved to consistently restore passive joint stability to the preinjury level, successful return to sport after ACLR appears to be predicated on numerous postsurgical factors. Importantly, a secondary ACL injury is most strongly related to modifiable postsurgical risk factors. Biomechanical abnormalities and movement asymmetries, which are more prevalent in this cohort than previously hypothesized, can persist despite high levels of functional performance, and also represent biomechanical and neuromuscular control deficits and imbalances that are strongly associated with secondary injury incidence. Decreased neuromuscular control and high-risk movement biomechanics, which appear to be heavily influenced by abnormal trunk and lower extremity movement patterns, not only predict first knee injury risk but also reinjury risk. These seminal findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. Evidence-based medicine (EBM) strategies should be used to develop effective, efficacious interventions targeted to these impairments to optimize the safe return to high-risk activity. In this Current Concepts article, the authors present the latest evidence related to risk factors associated with ligament failure or a secondary (contralateral) injury in athletes who return to sport after ACLR. From these data, they propose an EBM paradigm shift in postoperative rehabilitation and return-to-sport training after ACLR that is focused on the resolution of neuromuscular deficits that commonly persist after surgical reconstruction and standard rehabilitation of athletes. PMID:23041233

  14. [Alloplastic augmented femoral reinserted anterior cruciate liganent. Value of 2 channel augmentation for postoperative rehabilitation].

    PubMed

    Seitz, H; Wielke, B; Schlenz, I; Pichl, W; Vecsei, V

    1996-01-01

    The rupture of the anterior cruciate ligament (ACL) near its femoral origin is a common injury of the knee and can lead to lesions of the meniscus due to instability and to early gonarthrosis. One procedure applied in current orthopaedic practice to prevent such impairment of knee joint function is ACL repair reinforced with a synthetic intraarticular ligament. In this study we used twelve knees of cadavers and after sectioning the ACL in each repaired it according the Marshall technique with USP 1 PDS II sutures. We augmented the repair in each case with a 3-mm PET (Trevira hochfest) band inserted by the through-the-condyle (TTC) procedure and attached without preload to the femoral and tibial condyle with a 4-mm staple. We then measured the length of the ACL, the length of the Marshall sutures-ACL complex, the partial lengths, and the deviation angles and adherence-friction force of the 3-mm PET augmentation device, and applied the law of Hooke to calculate the load-sharing between the USP 1 PDS II sutures-ACL complex and the 3-mm PET band and between the ACL and the 3-mm PET band, respectively. We also evaluated the load on the femoral and the tibial fixation of the augmentation device. The results showed that the 3-mm PET band took over 60% of an externally applied load on the knee during the hypothetic period of ACL healing and 27% of the force acting on the knee thereafter. It was calculated that a maximum of 75% of the load taken over by the augmentation device was at the tibial staple and only up to 45% of the force at the femoral one. With due consideration for the requirement for absolute protection ("stress shielding") of the healing ACL but also for the aim of early postoperative accelerated functional rehabilitation without casts, splints or other restrictions of joint movement, we believe that a pretensioned 3-mm PET band is the best choice, since augmentation without preload cannot fulfil these requirements. PMID:8717169

  15. Morphological characterization of a novel scaffold for anterior cruciate ligament tissue engineering.

    PubMed

    Laurent, Cédric P; Ganghoffer, Jean-François; Babin, Jérôme; Six, Jean-Luc; Wang, Xiong; Rahouadj, Rachid

    2011-06-01

    Tissue engineering offers an interesting alternative to current anterior cruciate ligament (ACL) surgeries. Indeed, a tissue-engineered solution could ideally overcome the long-term complications due to actual ACL reconstruction by being gradually replaced by biological tissue. Key requirements concerning the ideal scaffold for ligament tissue engineering are numerous and concern its mechanical properties, biochemical nature, and morphology. This study is aimed at predicting the morphology of a novel scaffold for ligament tissue engineering, based on multilayer braided biodegradable copoly(lactic acid-co-(e-caprolactone)) (PLCL) fibers The process used to create the scaffold is briefly presented, and the degradations of the material before and after the scaffold processing are compared. The process offers varying parameters, such as the number of layers in the scaffold, the pitch length of the braid, and the fibers' diameter. The prediction of the morphology in terms of pore size distribution and pores interconnectivity as a function of these parameters is performed numerically using an original method based on a virtual scaffold. The virtual scaffold geometry and the prediction of pore size distribution are evaluated by comparison with experimental results. The presented process permits creation of a tailorable scaffold for ligament tissue engineering using basic equipment and from minimum amounts of raw material. The virtual scaffold geometry closely mimics the geometry of real scaffolds, and the prediction of the pore size distribution is found to be in good accordance with measurements on real scaffolds. The scaffold offers an interconnected network of pores the sizes of which are adjustable by playing on the process parameters and are able to match the ideal pore size reported for tissue ingrowth. The adjustability of the presented scaffold could permit its application in both classical ACL reconstructions and anatomical double-bundle reconstructions. The precise knowledge of the scaffold morphology using the virtual scaffold will be useful to interpret the activity of cells once it will be seeded into the scaffold. An interesting perspective of the present work is to perform a similar study aiming at predicting the mechanical response of the scaffold according to the same process parameters, by implanting the virtual scaffold into a finite element algorithm. PMID:21744936

  16. The effects of levofloxacin on rabbit anterior cruciate ligament cells in vitro

    SciTech Connect

    Deng, Yu; Chen, Biao; Qi, Yongjian [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China)] [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China); Magdalou, Jacques [UMR 7561 CNRS-Nancy Universite, Faculte de Medicine, Vandoeuvre-les-Nancy (France)] [UMR 7561 CNRS-Nancy Universite, Faculte de Medicine, Vandoeuvre-les-Nancy (France); Wang, Hui [Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan (China)] [Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan (China); Chen, Liaobin, E-mail: lbchen@whu.edu.cn [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China)] [Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan (China)

    2011-11-15

    Articular cartilage, epiphyseal growth plate and tendons have been recognized as targets of fluoroquinolone-induced connective tissue toxicity. The effects of fluoroquinolones on ligament tissues are still unknown. The aim of this study was to investigate the effects of levofloxacin, a typical fluoroquinolone antibiotic drug, on rabbit anterior cruciate ligament (ACL) cells in vitro. Rabbit ACL cells were treated with levofloxacin at different concentrations (0, 14, 28, 56, 112 and 224 {mu}M) and were assessed to determine the possible cytotoxic effects of levofloxacin on ACL cells. Levofloxacin, with concentrations ranging from 28 to 224 {mu}M, induced dose-dependent ACL cell apoptosis. Characteristic markers of programmed cell death and degenerative changes were identified by electron microscopy in the ACL cells treated with 28 {mu}M of levofloxacin. Moreover, levofloxacin significantly increased the mRNA expression of matrix metalloproteinase 3 (MMP-3) and MMP-13 and decreased the expression of tissue inhibitors of metalloproteinase 1 (TIMP-1) in a concentration-dependent manner; TIMP-3 and collagen type I alpha 1 (Col1A1) mRNA expression was not affected. Immunocytochemical analysis indicated that levofloxacin markedly increased the expression of active caspase-3 within a concentration range of 28 to 224 {mu}M, whereas a clear-cut decrease in Col1A1 expression was found with levofloxacin treatment concentrations of 112 and 224 {mu}M, compared to controls. Our data suggest that levofloxacin has cytotoxic effects on ACL cells characterized by enhanced apoptosis and decreased extracellular matrix, which suggest a potential adverse effect of fluoroquinolones. -- Highlights: Black-Right-Pointing-Pointer Levofloxacin has cytotoxic effect on rabbit ACL cells in vitro. Black-Right-Pointing-Pointer Levofloxacin induces apoptosis in ACL cells. Black-Right-Pointing-Pointer It decreases extracellular matrix by upregulation of matrix degrading enzymes. Black-Right-Pointing-Pointer ACL cells are more susceptible to cytotoxicity by fluoroquinolones. Black-Right-Pointing-Pointer Our study suggests a potential adverse effect of fluoroquinolones.

  17. A dynamic analysis of a functional brace for anterior cruciate ligament insufficiency

    Microsoft Academic Search

    Frank F. Cook; James E. Tibone; Fredrick C. Redfern

    1989-01-01

    A dynamic, in vivo, functional analysis of braces de signed for ACL insufficiency has never been reported. In this study, 14 athletes who had arthroscopically proven absent ACLs were evaluated in the Biomechan ics Laboratory at the Centinela Hospital Medical Center. None of the ligaments were repaired or reconstructed. Footswitch, high speed photography, and force place data were recorded while

  18. Secondary damage to the knee after isolated injury of the anterior cruciate ligament

    Microsoft Academic Search

    A. Finsterbush; U. Frankl; Y. Matan; G. Mann

    1990-01-01

    Between 1978 and 1984, we examined and performed arthroscopy on 1000 consecutive patients. Ninety-eight of the 1000 had isolated ACL damage. These cases do not include patients with initial ACL injuries combined with other intraarticular damage. Diagnosis was by physical and arthroscopic examination. Examination took place an average 13.6 months after injury. Of the 98 isolated ACL injuries, 56 were

  19. Clinical Comparison of Fixation Methods for Patellar Bone Quadriceps Tendon Autografts in Anterior Cruciate Ligament ReconstructionAbsorbable Cross-pins Versus Absorbable Screws

    Microsoft Academic Search

    Ottmar Gorschewsky; Robert Stapf; Laurent Geiser; Ulrich Geitner; Wolfram Neumann

    2007-01-01

    Background: Recently, the use of the quadriceps tendon transplant with bone block (patellar bone quadriceps tendon autografts) for anterior cruciate ligament reconstruction has increasingly been reported.Hypothesis: Clinical results after the implantation of a patellar bone quadriceps tendon autograft fixed with cross-pins or screws will show no significant difference between the 2 techniques with regard to stability, function, and subjective satisfaction.

  20. Chondroitin sulfate epitope (WF6) and hyaluronic acid as serum markers of cartilage degeneration in patients following anterior cruciate ligament injury

    Microsoft Academic Search

    Dumnoensun Pruksakorn; Sattaya Rojanasthien; Peraphan Pothacharoen; Sirichai Luevitoonvechkij; Prasit Wongtreratanachai; Siriwan Ong-chai; Prachya Kongtawelert

    2009-01-01

    Serum chondroitin sulfate epitope (WF6) and hyaluronic acid (HA) levels were determined to be of clinical relevance to an anterior cruciate ligament (ACL) injury. This cross-sectional study recruited participants from two distinct groups. Group A was comprised of 74 healthy controls, and group B consisted of 33 ACL injury patients. Serum samples were taken and assayed by a competitive immunoassay

  1. Metabolism and composition of the canine anterior cruciate ligament relate to differences in knee joint mechanics and predisposition to ligament rupture

    Microsoft Academic Search

    Eithne J. Comerford; John F. Tarlton; John F. Innes; Kenneth A. Johnson; Andrew A. Amis; Allen J. Bailey

    2005-01-01

    Purpose: The objective of this study was to determine whether differences in the composition and metabolism of the extracellular matrix (ECM) in canine anterior cruciate ligaments (ACLs) might relate to mechanical properties of the canine knee. Variations in ACL biochemistry and knee mechanics could account for divergent predispositions to ligament rupture.Methods: Eleven knee joints were obtained from both cadaveric Labrador

  2. The Effect of Joint-Compressive Load and Quadriceps Muscle Force on Knee Motion in the Intact and Anterior Cruciate Ligament-Sectioned Knee

    Microsoft Academic Search

    Peter A. Torzilli; Xianghua Deng; Russell F. Warren

    1994-01-01

    To determine the effect of an externally applied joint- compressive load and a quadriceps muscle force on knee motion, we tested nine intact cadaveric knees and four knees after sectioning of the anterior cruciate liga ment. Anteroposterior translation was measured at 0°, 15°, 30°, 45°, and 90° of knee flexion after the appli cation of an anteroposterior force of 100

  3. Ligament Stability Two to Six Years After Anterior Cruciate Ligament Reconstruction with Autogenous Patellar Tendon Graft and Participation in Accelerated Rehabilitation Program

    Microsoft Academic Search

    K. Donald Shelbourne; Thomas E. Klootwyk; John H. Wilckens; Mark S. De Carlo

    1995-01-01

    We studied patients who participated in our accelerated rehabilitation program after anterior cruciate ligament reconstructive surgery to determine if they showed signs of patellar tendon graft stretching. This program initiated in 1987 emphasizes early full hyperextension, early weightbearing as tolerated, and closed-chain functional activities with rapid return to sports when the patient has attained full range of motion, approximately 65%

  4. Prospective Clinical Comparisons of Anatomic Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction Procedures in 328 Consecutive Patients

    Microsoft Academic Search

    Eiji Kondo; Kazunori Yasuda; Hirotaka Azuma; Yoshie Tanabe; Tomonori Yagi

    2008-01-01

    Background: Several trials have been conducted to compare the clinical results between anatomic double-bundle and single-bundle anterior cruciate ligament (ACL) reconstruction procedures. In these studies, however, the number of patients was insufficient to compare the clinical results of the 2 procedures.Hypothesis: The anatomic double-bundle procedure may be significantly better concerning the anterior laxity and the pivot-shift test than the single-bundle

  5. Dynamic knee stability estimated by finite helical axis methods during functional performance approximately twenty years after anterior cruciate ligament injury.

    PubMed

    Helena, Grip; Eva, Tengman; Charlotte, K Häger

    2015-07-16

    Finite helical axis (FHA) measures of the knee joint during weight-bearing tasks may capture dynamic knee stability following Anterior Cruciate Ligament (ACL) injury. The aim was to investigate dynamic knee stability during two-leg squat (TLS) and one-leg side hop (SH) in a long-term follow-up of ACL injury, and to examine correlations with knee laxity (KT-1000), osteoarthritis (OA, Kellgren-Lawrence) and knee function (Lysholm score). Participants were injured 17-28 years ago and then treated with surgery (n=33, ACLR) or physiotherapy only (n=37, ACLPT) and healthy-knee controls (n=33) were tested. Movements were registered with an optical motion capture system. We computed three FHA inclination angles, its' Anterior-Posterior (A-P) position, and an index quantifying directional changes (DI), during stepwise knee flexion intervals of ?15°. Injured knees were less stable compared to healthy controls' and to contralateral non-injured knees, regardless of treatment: the A-P intersection was more anterior (indicating a more anterior positioning of tibia relative to femur) positively correlating with high laxity/low knee function, and during SH, the FHA was more inclined relative to the flexion-extension axis, possibly due to reduced rotational stability. During the TLS, A-P intersection was more anterior in the non-injured knee than the injured, and DI was higher, probably related to higher load on the non-injured knee. ACLR had less anterior A-P intersection than ACLPT, suggesting that surgery enhanced stability, although rotational stability may remain reduced. More anterior A-P intersection and greater inclination between the FHA and the knee flexion-extension axis best revealed reduced dynamic stability ?23 years post-injury. PMID:25935685

  6. Proceedings of the ESSKA Scientific Workshop on Reconstruction of the Anterior and Posterior Cruciate Ligaments

    Microsoft Academic Search

    A. A. Amis; B. Beynnon; L. Blankevoort; P. Chambat; P. Christel; L. Durselen; N. Friederich; E. Grood; P. Hertel; R. Jakob; W. Müller; M. O'Brien; J. O'Connor

    1994-01-01

    Conclusions This document has resulted from some intense debate between members of a group experienced in cruciate ligament surgery and research. Definite recommendations had the agreement of the group, while the absence of a firm viewpoint has led to recommendations for further research.

  7. Avaliação da qualidade de vida de pacientes submetidos a reconstrução do ligamento cruzado anterior e a um programa de reabilitação Assessment of quality of life of patients who underwent anterior cruciate ligament reconstruction and a rehabilitation program

    Microsoft Academic Search

    Priscila Zeitune Nigri; Flavia Machado Orlando; Ana Lucia; Wirz Gava; Maria Stella Peccin; Moises Cohen

    Introduction: Quality of life can be defined as the expression of a conceptual model that tries to represent patient's perspectives and his\\/her level of satisfaction expressed by numbers. The objective of this study is to evaluate the parameters of quality of life of 23 patients who underwent surgery for anterior cruciate ligament reconstruction. Methods: We adopted SF-36, a generic questionnaire

  8. Reconstruction of the anterior cruciate ligament: dynamic strain evaluation of the graft.

    PubMed

    Handl, Milan; Drzík, Milan; Cerulli, Giuliano; Povýsil, Ctibor; Chlpík, Juraj; Varga, Ferdinand; Amler, Evzen; Trc, Tomás

    2007-03-01

    The study is focused on the biomechanical aspects of the anterior cruciate ligament (ACL) reconstruction procedures with an emphasis on evaluating the dynamic strain of materials commonly used for this purpose. Separate and multiple, equally tensioned strands of hamstring grafts used for the reconstruction of the ACL were biomechanically tested and compared to original ACL and bone-patellar tendon-bone (BPTB) grafts, using tissue samples from cadavers. The study was focused on measuring such material properties as the strength, stiffness, maximum load, and elongation at maximum load of the original ACL, BPTB graft, and single tendon hamstring (gracilis and semitendinosus) grafts, continued by double strands and finally by four-strand graft (STG) evaluation. Fresh-frozen cadaveric knees were used, which had been clamped and tensioned equally. The measurement was performed by drop-weight testing, using a Laser Doppler Vibrometer as a basic sensor of the dynamic movements of the gripping clamps, with parallel correlation by a piezoelectric transducer. The grafts for experiments were obtained from 21-paired knees. The measurement was performed at room temperature (21 degrees C) after 24 h of thawing at 4 degrees C. All the specimens were measured for their response to the dynamic tensile load. The maximum strength values were obtained and calculated for the appropriate section area of the specimen. The tensioned strands of the original ACL showed a maximum average load of 1,246 +/- 243 N in the section area of about 30 mm(2) (max. stress 41.3 MPa); the strands of BPTB grafts showed values of 3,855 +/- 550 N in the section area of 80 mm(2) (max. stress 40.6 MPa); the gracilis tendons showed 925 +/- 127 N in the section area of 10 mm(2) (max. stress 95.1 MPa) and the semitendinosuss yielded a result of 2,050 +/- 159 N in the area of 20 mm(2) (max. stress 88.7 MPa). Of all the materials, the original ACL have the lowest strength and stiffness in respect of their biomechanical properties. BPTB grafts showed a slightly higher value of maximum stress, while both the gracilis and semitendinosus tendons showed double the value of maximum load per section area-tensile stress. Two- and four- combined hamstring strands clamped together and equally tensioned with a drop-weight had the combined tensile strength properties of the individual strands within the estimated range of measurement errors. No significant changes in maximum loads/stresses were observed under impact loading conditions. The results of this study demonstrate that equally tensioned four-strand hamstring-tendon grafts have higher initial tensile properties than those in other varieties of samples. From a biomechanical point of view, they seem to be a reasonable alternative procedure for ACL reconstruction. PMID:16972110

  9. Physeal-Sparing Technique for Femoral Tunnel Drilling in Pediatric Anterior Cruciate Ligament Reconstruction Using a Posteromedial Portal

    PubMed Central

    Lemos, Stephen E.; Keating, Patrick M.; Scott, Timothy P.; Siwiec, Ryan M.

    2013-01-01

    Pediatric anterior cruciate ligament (ACL) tears present a technical dilemma for orthopaedic surgeons. Multiple surgical techniques have been described to protect the distal femoral and proximal tibial physes. We present an ACL reconstruction technique performed on a 12-year-old girl with open physes who sustained an ACL tear after a noncontact twisting injury while playing soccer. A hamstring autograft reconstruction was performed by use of a posteromedial portal to drill the femoral tunnel in an all-epiphyseal fashion at the anatomic footprint of the native ACL. This case provides a new surgical technique to achieve anatomic fixation for ACL reconstruction in a skeletally immature individual using a posteromedial portal to drill a physeal-sparing lateral femoral tunnel for anatomic ACL reconstruction. This advancement may make drilling the femoral tunnel less technically challenging compared with other proposed methods while maintaining the lateral wall of the distal femur. PMID:24892013

  10. The incidence of knee and anterior cruciate ligament injuries over one decade in the Belgian Soccer League.

    PubMed

    Quisquater, Laurent; Bollars, Peter; Vanlommel, Luc; Claes, Steven; Corten, Kristoff; Bellemans, Johan

    2013-10-01

    In an epidemiological study we assessed the evolution in the incidence and possible risk factors of knee injuries, especially anterior cruciate ligament (ACL) injuries, in Belgian soccer over one decade. Two soccer seasons (1999-2000 and 2009-2010) were compared and 56,364 injury reports registered by the KBVB-URBSFA were retrieved. Knee injuries totaled 9.971 cases, 5.495 in the first season (1999-2000) and 4.476 in the second (2009-2010): a significant decrease in incidence from 1.5 per 100 players in 2000 to 1.2 knee injuries in 2010. Six percent of all knee injuries were ACL injuries. The reported incidence of ACL tears slightly increased from 0.081 to 0.084 per 100 players. Female gender, competition and age over 18 years were prognosticators for ACL injuries. Enhanced prevention programs for ACL injuries, especially in those sports groups are warranted. PMID:24350516

  11. Tibia Rotational Technique to Drill Femoral Bone Tunnel in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Mitani, Genya; Takagaki, Tomonori; Hamahashi, Kosuke; Kaneshiro, Nagatoshi; Serigano, Kenji; Maeda, Takashi; Nakamura, Yutaka; Mochida, Joji

    2014-01-01

    In anatomic anterior cruciate ligament (ACL) reconstruction, several pitfalls in creating the femoral bone tunnels at the correct position are of great concern. Our new method, the tibia rotational (TR) technique, may contribute to resolving these. The purpose of this study is to describe further details about the TR technique in anatomic double-bundle ACL reconstruction. Both anteromedial and posterolateral femoral bone tunnels were drilled through a posterolateral tibial bone tunnel using tibial rotation without deep knee flexion. When it is difficult to reach the mark with the rigid guide pin, the narrow curved TR technique guide and the flexible drill system allow drilling femoral bone tunnels in the correct position. The TR technique offers the technical ease required for widespread acceptance while prioritizing the fundamental goals of an anatomic double-bundle ACL reconstruction. PMID:25276609

  12. Effects of closed kinetic chain exercises on proprioception and functional scores of the knee after anterior cruciate ligament reconstruction.

    PubMed

    Cho, Sung-Hyoun; Bae, Chang-Hwan; Gak, Hwang-Bo

    2013-10-01

    [Purpose] The purpose of this study was to examine the effect of closed kinetic chain exercises performed by an unstable exercise group (UEG) and a stable exercise group (SEG) on the knee joint, proprioception, and functional scores of patients who underwent anterior cruciate ligament (ACL) reconstruction. [Subjects] Twenty-eight patients participated in this study. The exclusion criteria were fracture or neurological disease. [Methods] The subjects were randomly assigned to one of two groups, each with 14 people. Each group took part in a 60-minute exercise program, three times a week for six weeks. [Results] The results of the clinical evaluation at 45°proprioception showed statistically significant differences between the two groups. The results of the clinical evaluation at 15°proprioception showed no statistically significant differences between the two groups. [Conclusion] The proprioception and functional scores of the patients in the UEG who underwent ACL reconstruction were superior to those in the SEG group. PMID:24259766

  13. Lateral tibial avulsion fractures and disruptions to the anterior cruciate ligament. A clinical study of their incidence and correlation.

    PubMed

    Hess, T; Rupp, S; Hopf, T; Gleitz, M; Liebler, J

    1994-06-01

    Avulsion fractures of the lateral tibial plateau, known as the lateral capsular sign, are increasingly associated with anterior cruciate ligament (ACL) ruptures. This phenomenon, known as the Ségond fracture, is a bony avulsion of the menisco-tibial ligament. Stress, which can lead to an avulsion of this kind, almost always occurs during knee flexion and internal tibial rotation, and in most cases only after damage to the primary ACL stabilizer. Examination of 151 ACL ruptures revealed a Ségond fracture in 9% of patients. Nearly all were caused by sports injuries and, understandably, the accident mechanism always included knee flexion and internal rotation of the tibial. In a similarly large number of other knee injuries without damage to the ACL, only one case of a Ségond fracture was found. This phenomenon, which is easy to detect by radiograph, can thus be regarded as a strong indication of the presence of a ligament injury. PMID:8194233

  14. Clinical Correlates to Laboratory Measures for use in Non-Contact Anterior Cruciate Ligament Injury Risk Prediction Algorithm

    PubMed Central

    Myer, Gregory D.; Ford, Kevin R.; Khoury, Jane; Succop, Paul; Hewett, Timothy E.

    2010-01-01

    Background Prospective measures of high knee abduction moment during landing identify female athletes at high risk for non-contact anterior cruciate ligament injury. Biomechanical laboratory measurements predict high knee abduction moment landing mechanics with high sensitivity (85%) and specificity (93%). The purpose of this study was to identify correlates to laboratory-based predictors of high knee abduction moment for use in a clinic-based anterior cruciate ligament injury risk prediction algorithm. The hypothesis was that clinically obtainable correlates derived from the highly predictive laboratory-based models would demonstrate high accuracy to determine high knee abduction moment status. Methods Female basketball and soccer players (N=744) were tested for anthropometrics, strength and landing biomechanics. Pearson correlation was used to identify clinically feasible correlates and logistic regression to obtain optimal models for high knee abduction moment prediction. Findings Clinical correlates to laboratory-based measures were identified and predicted high knee abduction moment status with 73% sensitivity and 70% specificity. The clinic-based prediction algorithm, including (Odds Ratio: 95% confidence interval) knee valgus motion (1.43:1.30–1.59 cm), knee flexion range of motion (.98:0.96–1.01 deg), body mass (1.04:1.02–1.06 kg), tibia length (1.38:1.25–1.52 cm) and quadriceps to hamstring ratio (1.70:1.06–2.70) predicted high knee abduction moment status with C statistic 0.81. Interpretation The combined correlates of increased knee valgus motion, knee flexion range of motion, body mass, tibia length and quadriceps to hamstrings ratio predict high knee abduction moment status in female athletes with high sensitivity and specificity. PMID:20554101

  15. Insufficiency fracture of the tibial plateau after anterior cruciate ligament reconstructive surgery: a case report and review of the literature.

    PubMed

    Wong, Jessica J; Muir, Brad

    2013-06-01

    Peri-articular fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. To our knowledge, this case documents the first insufficiency fracture of the tibial plateau after ACL reconstruction, which presented three weeks after the procedure. A 25-year-old female recreational soccer player suffered an insufficiency fracture of the tibial plateau, extending 1.5 mm into the anterior wall of tibial tunnel and medial compartment under the anterior horn of medial meniscus, which presented as a diagnostic challenge. Clinically, the fracture mimicked a low-grade infection of the surgical site, while radiographically, the fracture resembled an avulsion fracture, later confirmed as a tibial tunnel fracture with computed tomography. With the ACL graft integrity not in jeopardy, four weeks of non-weightbearing and a delayed post-operative rehabilitation program was effective in allowing the fracture to heal. Good functional outcome was achieved after conservative management, with minimal loss of terminal knee extension and minimal pain at 22-month follow-up. PMID:23754857

  16. First-time anterior shoulder dislocations: should they be arthroscopically stabilised?

    PubMed Central

    Sedeek, Sedeek Mohamed; Bin Abd Razak, Hamid Rahmatullah; Ee, Gerard WW; Tan, Andrew HC

    2014-01-01

    The glenohumeral joint is inherently unstable because the large humeral head articulates with the small shadow glenoid fossa. Traumatic anterior dislocation of the shoulder is a relatively common athletic injury, and the high frequency of recurrent instability in young athletes after shoulder dislocation is discouraging to both the patient and the treating physician. Management of primary traumatic shoulder dislocation remains controversial. Traditionally, treatment involves initial immobilisation for 4–6 weeks, followed by functional rehabilitation. However, in view of the high recurrence rates associated with this traditional approach, there has been an escalating interest in determining whether immediate surgical intervention can lower the rate of recurrent shoulder dislocation, improving the patient’s quality of life. This review article aims to provide an overview of the nature and pathogenesis of first-time primary anterior shoulder dislocations, the widely accepted management modalities, and the efficacy of primary surgical intervention in first-time primary anterior shoulder dislocations. PMID:25631890

  17. The Role of Fibers in the Femoral Attachment of the Anterior Cruciate Ligament in Resisting Tibial Displacement

    PubMed Central

    Kawaguchi, Yasuyuki; Kondo, Eiji; Takeda, Ryo; Akita, Keiichi; Yasuda, Kazunori; Amis, Andrew A.

    2015-01-01

    Purpose The purpose was to clarify the load-bearing functions of the fibers of the femoral anterior cruciate ligament (ACL) attachment in resisting tibial anterior drawer and rotation. Methods A sequential cutting study was performed on 8 fresh-frozen human knees. The femoral attachment of the ACL was divided into a central area that had dense fibers inserting directly into the femur and anterior and posterior fan-like extension areas. The ACL fibers were cut sequentially from the bone: the posterior fan-like area in 2 stages, the central dense area in 4 stages, and then the anterior fan-like area in 2 stages. Each knee was mounted in a robotic joint testing system that applied tibial anteroposterior 6-mm translations and 10° or 15° of internal rotation at 0° to 90° of flexion. The reduction of restraining force or moment was measured after each cut. Results The central area resisted 82% to 90% of the anterior drawer force; the anterior fan-like area, 2% to 3%; and the posterior fan-like area, 11% to 15%. Among the 4 central areas, most load was carried close to the roof of the intercondylar notch: the anteromedial bundle resisted 66% to 84% of the force and the posterolateral bundle resisted 16% to 9% from 0° to 90° of flexion. There was no clear pattern for tibial internal rotation, with the load shared among the posterodistal and central areas near extension and mostly the central areas in flexion. Conclusions Under the experimental conditions described, 66% to 84% of the resistance to tibial anterior drawer arose from the ACL fibers at the central-proximal area of the femoral attachment, corresponding to the anteromedial bundle; the fan-like extension fibers contributed very little. This work did not support moving a single-bundle ACL graft to the side wall of the notch or attempting to cover the whole attachment area if the intention was to mimic how the natural ACL resists tibial displacements. Clinical Relevance There is ongoing debate about how best to reconstruct the ACL to restore normal knee function, including where is the best place for ACL graft tunnels. This study found that the most important area on the femur, in terms of resisting displacement of the tibia, was in the central-anterior part of the femoral ACL attachment, near the roof of the intercondylar notch. The testing protocol did not lead to data that would support using a large ACL graft tunnel that attempts to cover the whole natural femoral attachment area. PMID:25530509

  18. Arthroscopic Identification of the Anterolateral Ligament of the Knee

    PubMed Central

    Sonnery-Cottet, Bertrand; Archbold, Pooler; Rezende, Fernando C.; Neto, Ayrton M.; Fayard, Jean-Marie; Thaunat, Mathieu

    2014-01-01

    Intense interest has focused on the recent description of the anterolateral ligament of the knee. Advancing knowledge of its anatomy and function is leading to a realization of its importance in the rotatory control of the tibia in anterior cruciate ligament injuries. Reconstruction of this structure will increasingly become an important goal during anterior cruciate ligament reconstruction. However, preoperative assessment of this ligament is difficult. Clinical assessment of rotatory laxity has poor reproducibility, and it is difficult to define using current imaging techniques. This article is the first to describe a safe and reproducible arthroscopic technique to allow identification and examination of the anterolateral ligament of the knee. With the knee at 90° of flexion, the arthroscope is introduced through the anterolateral portal to allow clear visualization of the lateral gutter. Under direct vision, an accessory portal is made over the inferior limit of the lateral gutter. A shaver is then introduced through this portal and used to debride this synovial recess and define the anterolateral ligament. This allows the surgeon to examine the integrity of the anterolateral ligament, in particular its femoral insertion. If required, this additional information can facilitate the performance of a more accurate and effective extra-articular reconstruction. PMID:25126509

  19. Lack of Correlation between Dynamic Balance and Hamstring-to-Quadriceps Ratio in Patients with Chronic Anterior Cruciate Ligament Tears

    PubMed Central

    Lee, Jin-Hyuck; Jeong, Hye-Jin; Lee, Seok-Joo

    2015-01-01

    Purpose The purpose of this study was to evaluate the quadriceps and hamstring muscle strength and hamstring-to-quadriceps (HQ) ratio, as well as the relationships of these parameters with dynamic balance, in patients with anterior cruciate ligament (ACL) rupture. Materials and Methods We compared 25 patients diagnosed with chronic unilateral ACL tears and 25 age-matched healthy volunteers. The maximal torque of the quadriceps and hamstring and dynamic balance were measured. Results Although the isokinetic maximal peak torques were about 50% lower in the quadriceps (57%, p<0.001) and hamstring (56%, p=0.001) muscles in the chronic ACL tear group than in the control group, their HQ ratios were similar (56%±17% vs. 58%±6%, p=0.591). HQ ratio was significantly correlated with anterior-posterior stability index (r=-0.511, p=0.021) and overall stability index (r=-0.476, p=0.034) in control group, but these correlations were not observed in chronic ACL tear group. Conclusions Thigh muscle strength was about 50% lower in the chronic ACL tear group than in the control group, but the HQ ratio was similar. The dynamic balance of the knee was not influenced by thigh muscle strength but was influenced by HQ ratio in healthy young individuals. However, HQ ratio was not correlated with dynamic knee balance in chronic ACL tear patients. PMID:26060609

  20. Biomechanical testing of quadriceps tendon–patellar bone grafts: an alternative graft source for press-fit anterior cruciate ligament reconstruction?

    Microsoft Academic Search

    Jens Dargel; Rüdiger Schmidt-Wiethoff; Thomas Schneider; Gert-Peter Brüggemann; Jürgen Koebke

    2006-01-01

    Introduction: Press-fit fixation of bone-patellar tendon–bone (BPTB) grafts in anterior cruciate ligament (ACL) reconstruction has been analyzed biomechanically in previous studies; however, the use of quadriceps tendon–patellar bone (QTPB) grafts has not been studied so far. It is hypothesized that QTPB grafts provide primary fixation strength comparable to BPTB grafts in press-fit ACL reconstruction with respect to bone plug length

  1. Histological and biomechanical studies of inter-strand healing in four-strand autograft anterior cruciate ligament reconstruction in a rabbit model

    Microsoft Academic Search

    Yan Xu; Ying-fang Ao

    2009-01-01

    In order to observe the remodeling process of the inter-strand of the four-strand graft used for anterior cruciate ligament\\u000a (ACL) reconstruction, and to find the histological and biomechanical influences on this process by braiding the four-strand\\u000a graft, we conducted this study in a rabbit model. The rabbit’s ACLs were reconstructed with bilateral four-strand semitendinous\\u000a tendons which are in parallel or

  2. Systematic Review of Single-Bundle Anterior Cruciate Ligament Reconstruction OutcomesA Baseline Assessment for Consideration of Double-Bundle Techniques

    Microsoft Academic Search

    Paul B. Lewis; A. Dushi Parameswaran; John-Paul H. Rue; Bernard R. Bach

    2008-01-01

    Background: There is increasing interest in comparing the efficacy of single-bundle versus double-bundle anterior cruciate ligament reconstruction. Challenging this comparison, however, has been the lack of an established consensus on the success of single-bundle reconstruction.Hypothesis: The current outcomes of single-bundle reconstruction can be clarified from a large unbiased body of evidence for future comparisons with double-bundle reconstructions.Study Design: Systematic review.Methods:

  3. The Effect of Graft Fixation Angles on Anteroposterior and Rotational Knee Laxity in Double-Bundle Anterior Cruciate Ligament Reconstruction: Evaluation Using Computerized Navigation

    Microsoft Academic Search

    Hideyuki Koga; Takeshi Muneta; Kazuyoshi Yagishita; Young-Jin Ju; Ichiro Sekiya

    2012-01-01

    Background: One of the main differences affecting outcome between single-bundle and double-bundle anterior cruciate ligament (ACL) reconstructions may be graft fixation angles and initial force settings; however, there has been little research to investigate these effects in either technique.Hypothesis: Anteroposterior and rotational knee laxities will be less in double-bundle ACL reconstructions than single-bundle reconstructions, and different graft fixation angles affect

  4. Winner of the 2007 Systematic Review Competition: Outcome of Single-Bundle Versus Double-Bundle Reconstruction of the Anterior Cruciate LigamentA Meta-Analysis

    Microsoft Academic Search

    Richard B. Meredick; Kennan J. Vance; David Appleby; James H. Lubowitz

    2008-01-01

    Background: The anterior cruciate ligament (ACL) has 2 anatomic bundles. Standard ACL reconstruction is with a single-bundle graft, but double-bundle reconstruction may better control knee rotational torque, a potential cause of failure after single-bundle reconstruction. The authors investigated outcomes of single-bundle versus double-bundle ACL reconstruction. Hypothesis: There is no difference in outcomes of single-bundle versus double-bundle reconstruction.Study Design: Meta-analysis.Methods: The

  5. Single-Bundle Anterior Cruciate Ligament ReconstructionA Comparison of Conventional, Central, and Horizontal Single-Bundle Virtual Graft Positions

    Microsoft Academic Search

    Robert H. Brophy; Andrew D. Pearle

    2009-01-01

    Background: Conventional endoscopic single-bundle transtibial anterior cruciate ligament (ACL) reconstruction from the posterolateral tibial footprint to the anteromedial femoral footprint results in a vertical graft. A more oblique horizontal graft from the anteromedial tibial footprint to the posterolateral femoral footprint may offer a better alternative for all endoscopic ACL reconstruction.Hypothesis: When compared with a conventional ACL single-bundle position, the horizontal

  6. A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system

    Microsoft Academic Search

    Daisuke Araki; Ryosuke Kuroda; Seiji Kubo; Norifumi Fujita; Katsumasa Tei; Koji Nishimoto; Yuichi Hoshino; Takehiko Matsushita; Tomoyuki Matsumoto; Koki Nagamune; Masahiro Kurosaka

    2011-01-01

    We conducted a prospective randomised study of anatomical single-bundle (A-SB group) versus double-bundle (A-DB group) anterior\\u000a cruciate ligament (ACL) reconstruction using the hamstrings tendons. Twenty patients with unilateral ACL deficiency were randomised\\u000a into two groups. We created the bone tunnels at the position of the original insertion of the anteromedial bundle footprint\\u000a and posterolateral bundle footprint in the A-DB group

  7. The Relationship Between Femoral Tunnels Created by the Transtibial, Anteromedial Portal, and Outside-In Techniques and the Anterior Cruciate Ligament Footprint

    Microsoft Academic Search

    Hemanth R. Gadikota; Jae Ang Sim; Ali Hosseini; Thomas J. Gill; Guoan Li

    2012-01-01

    Background: Tunnels created for reconstruction of a torn anterior cruciate ligament (ACL) are critical determinants of joint stability and clinical outcomes. There is limited objective evidence on the ability of transtibial (TT), anteromedial (AM) portal, and outside-in (OI) operative techniques in creating anatomic tunnels.Hypothesis: (1) Tibial tunnel–independent techniques can create tunnels more accurately at the anatomic ACL footprint center than

  8. Two to 4Year Follow-up to a Comparison of Home Versus Physical Therapy-Supervised Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction

    Microsoft Academic Search

    John A. Grant; Nicholas G. H. Mohtadi

    2010-01-01

    Background: There have been no long-term follow-up studies comparing a predominantly home-based rehabilitation program with a standard physical therapy program after anterior cruciate ligament (ACL) reconstruction. Demonstrating the long-term success of such a cost-effective program would be beneficial to guide future rehabilitation practice.Purpose: To determine whether there were any differences in long-term outcome between recreational athletes who performed a physical

  9. Evaluating the Center of Gravity of Dislocations in Soccer Players With and Without Reconstruction of the Anterior Cruciate Ligament Using a Balance Platform

    PubMed Central

    Alonso, Angelica Castilho; Greve, Júlia Maria D’Andréa; Camanho, Gilberto Luis

    2009-01-01

    OBJECTIVE The objective of this study was to compare the dislocation of the center of gravity and postural balance in sedentary and recreational soccer players with and without anterior cruciate ligament (ACL) reconstruction using the Biodex Balance System (BBS). METHOD Sixty-four subjects were divided into three groups: a) soccer players who were post- anterior cruciate ligament reconstruction; b) soccer players with no anterior cruciate ligament injuries; and c) sedentary subjects. The subjects were submitted to functional stability tests using the Biodex Balance System. The instability protocols used were level eight (more stable) and level two (less stable). Three stability indexes were calculated: the anteroposterior stability index, the mediolateral stability index, and the general stability index. RESULTS Postural balance (dislocation) on the reconstructed side of the athletes was worse than on the side that had not undergone reconstruction. The postural balance of the sedentary group was dislocated less on both sides than the reconstructed knees of the athletes without anterior cruciate ligament injuries. There were no differences in postural balance with relation to left/right dominance for the uninjured athletes and the sedentary individuals. CONCLUSION The dislocation of the center of gravity and change in postural balance in sedentary individuals and on the operated limb of Surgery Group are less marked than in the soccer players from the Non Surgery Group and on the non-operated limbs. The dislocation of the center of gravity and the change in postural balance from the operated limb of the soccer players is less marked than in their non-operated limbs. PMID:19330239

  10. Anatomic double-bundle posterior cruciate ligament reconstruction using double-double tunnel with tibial anterior and posterior fresh-frozen allograft.

    PubMed

    Makino, Arturo; Aponte Tinao, Luis; Ayerza, Miguel Angel; Pascual Garrido, Cecilia; Costa Paz, Matias; Muscolo, Domingo Luis

    2006-06-01

    Techniques for the reconstruction of knee ligaments must restore the injured knee to a satisfactory level of performance. For this, a precise anatomic reconstruction is necessary. Many arthroscopic techniques for reconstruction of the posterior cruciate ligament (PCL) have been reported to restore the normal anatomy of the intact PCL using a double-bundle reconstruction with a Y-shaped tendon graft (2 femoral tunnel and 1 tibial tunnel). However, this procedure is sometimes difficult because the graft must be tightened in different grades of flexion to obtain complete strength of both bundles. We thought that double-bundle PCL reconstruction using double-double tunnels (2 femoral and 2 tibial tunnels) would allow an anatomic reconstruction, restoring better knee biomechanics, and probably improving patient outcome. PMID:16762716

  11. Biomechanical testing of implant free wedge shaped bone block fixation for bone patellar tendon bone anterior cruciate ligament reconstruction in a bovine model

    PubMed Central

    2010-01-01

    Background The use of an interference fit wedged bone plug to provide fixation in the tibial tunnel when using bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction offers many theoretic advantages including the potential to offer a more economical and biological alternative to screw fixation. This technique has not been subjected to biomechanical testing. We hypothesised that a wedged bone plug fixation technique provides equivalent tensile load to failure as titanium interference screw fixation. Methods In a controlled laboratory setting, anterior cruciate ligament reconstruction was performed in 36 bovine knees using bone-patella-bone autograft. In 20 knees tibial fixation relied upon a standard cuboid bone block and interference screw. In eight knees a wedge shaped bone block with an 11 mm by 10 mm base without a screw was used. In a further eight knees a similar wedge with a 13 mm by 10 mm base was used. Each specimen used a standard 10 mm tibial tunnel. The reconstructions were tested biomechanically in a physiological environment using an Instron machine to compare ultimate failure loads and modes of failure. Results Statistical analysis revealed no significant difference between wedge fixation and screw fixation (p = 0.16), or between individual groups (interference screw versus 11 mm versus 13 mm wedge fixation) (P = 0.35). Conclusions Tibial tunnel fixation using an impacted wedge shaped bone block in anterior cruciate ligament reconstruction has comparable ultimate tensile strength to titanium interference screw fixation. PMID:20813059

  12. Anatomic Single Bundle Anterior Cruciate Ligament Reconstruction by Low Accessory Anteromedial Portal Technique: An In Vivo 3D CT Study

    PubMed Central

    Lee, Kwang Won; Chi, Yong Joo; Yang, Dae Suk; Kim, Ha Yong; Choy, Won Sik

    2014-01-01

    Purpose Proper femoral tunnel position is important for anatomical reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to evaluate the positions of femoral and tibial tunnels created using an accessory anteromedial portal technique in single bundle ACL reconstruction. Materials and Methods The femoral tunnel was targeted at the mid-portion of the ACL bundles. We evaluated postoperative computed tomography scans of 32 patients treated by ACL reconstruction using a free-hand low accessory anteromedial portal technique. On the tibial side, the tunnel position was evaluated using Tsukada's method. On the femoral side, the position was evaluated using 1) the quadrant method, 2) Mochizuki's method, 3) Mochizuki's method, and 4) Takahashi's method. Tunnel obliquity was also evaluated. Results The mean tibial tunnel position was located at 44.6%±2.5% anterior from the anterior margin and 48.0%±3.0% in medial from the medial margin. The mean femoral tunnel position was located at the center between the anteromedial and posterolateral bundles: Quadrant method, 26.7%±2.7%/30.0%±2.9%; Watanabe's method, 37.7%±2.5%/26.6%±2.2%; Mochizuki's method, 38.7%±2.7%; Takahashi's method, 21.8%±2.2%. The mean femoral tunnel obliquity was 57.7°±6.2° in the sagittal plane and 49.9°±5.6° in the coronal plane. Conclusions In anatomic single bundle ACL reconstruction, the low anteromedial portal technique can restore accurate position of the native footprint. Accurate femoral tunnel position facilitates recovery of stability and decreases graft failure rate. PMID:24944975

  13. Clinical Results of Technique for Double Bundle Anterior Cruciate Ligament Reconstruction Using Hybrid Femoral Fixation and Retroscrew

    PubMed Central

    Kim, Doo-Sup; Yi, Chang-Ho; Chung, Hoi-Jung

    2011-01-01

    Background Anatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restore the native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstruction and to evaluate the clinical outcome. Methods Grafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft without detachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fixation was done by hybrid fixation using Endobutton and Rigidfix for AMB and by biointerference screw for PLB. Tibial fixations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independently and differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participated in this study. The patients were followed up with clinical examination, Lysholm scales and International Knee Documentation Committee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration. Results Significant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Only one of participants had flexion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvement from average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. Average Lysholm score of all patients was 72.7 ± 8.8 (range, 54 to 79) preoperatively and significant improvement was seen, score was 92.2 ± 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormal in 1 case at last follow-up. Conclusions Our new double bundle ACL reconstruction technique used hybrid fixation and Retroscrew had favorable outcomes. PMID:22162791

  14. Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence

    PubMed Central

    Papalia, Rocco; Torre, Guglielmo; Vasta, Sebastiano; Zampogna, Biagio; Pedersen, Douglas R; Denaro, Vincenzo; Amendola, Annunziato

    2015-01-01

    Background Bone bruises are frequently associated with anterior cruciate ligament (ACL) tears as a result of trauma or direct shear stress of the bone. Purpose To review the evidence regarding the characteristics of the bone bruise associated with ACL tears, its relevance on clinical outcomes, and its progression over time. In particular, the long-term effects of the bone bruise on the knee osteochondral architecture and joint function were evaluated. Study design Review; level of evidence: 4. Methods An electronic search was performed on PubMed. Combinations of keywords included: “bone bruise AND knee”; “bone bruise AND anterior cruciate ligament”; “bone bruise AND osteo-chondral defects”. Any level of evidence studies concerning bone bruises in patients with partial or complete ACL tears were retrieved. Results A total of 25 studies were included; three of them investigated biomechanical parameters, seven were concerned with clinical outcomes, and 15 were radiological studies. Evaluation of the bone bruise is best performed using a fat-saturated T2-weighted fast spin echo exam or a short tau inversion recovery sequence where fat saturation is challenging. The location of the injury has been demonstrated to be more frequent in the lateral compartment of the joint (lateral femoral condyle and lateral tibial plateau). It is associated with ACL tears in approximately 70% of cases, often with collateral ligament or meniscal tears. Mid- and long-term outcomes demonstrated a complete healing of the marrow lesions at magnetic resonance imaging, but chondral defects detected with T1? sequences are still present 1 year after the ACL injury. Functional examination of the knee, through clinical International Knee Documentation Committee scores, did not show any correlation with the bone bruise. Conclusion Although bone bruise presence yields to higher pain levels, no correlation with functional outcomes was reported. Most studies have a short-term follow-up (<2 years) compared to the length of time it takes to develop post-traumatic osteoarthritis, so it still remains unclear whether the initial joint injury and bone bruise have a direct relationship to long-term function. PMID:25733936

  15. Assessment of quality of life of patients who underwent anterior cruciate ligament reconstruction and a rehabilitation program Avaliação da qualidade de vida de pacientes submetidos à reconstrução do ligamento cruzado anterior e a um programa de reabilitação

    Microsoft Academic Search

    Priscila Zeitune Nigri; Flavia Machado Orlando; Ana Lucia; Wirz Gava; Maria Stella Peccin; Moises Cohen

    Introduction: Quality of life can be defined as the expression of a conceptual model that tries to represent patient's perspectives and his\\/her level of satisfaction expressed by numbers. The objective of this study is to evaluate the parameters of quality of life of 23 patients who underwent surgery for anterior cruciate ligament reconstruction. Methods: We adopted SF-36, a generic health-related

  16. Bilateral simultaneous anterior cruciate ligament injury: a case report and national survey of orthopedic surgeon management preference.

    PubMed

    Saadat, Ehsan; Curry, Emily J; Li, Xinning; Matzkin, Elizabeth G

    2014-10-27

    Unilateral anterior cruciate ligament (ACL) tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States) to determine the prevalence of simultaneous bilateral ACL tear and preferred management strategies by sports medicine orthopedic surgeons. Sports medicine fellowship directors were contacted and asked to send an 8-item survey to colleagues (sports medicine fellowship trained surgeons) asking about overall number of ACL reconstructions performed, number of bilateral simultaneous ACL injuries seen and optimal management strategies of such an injury. Out of 43 responses, only 22 (51.2%) surgeons had seen a bilateral simultaneous ACL injury. Of these, 16 (76.2%) preferred staged reconstruction. Graft choice was mixed between autograft and allograft, but a large majority preferred either patellar tendon autograft (58%) or hamstring autograft (41%) were the most common choice. Staged reconstruction is the treatment of choice by surgeons surveyed in our study. PMID:25568728

  17. Anatomic Double-Bundle Reinsertion After Acute Proximal Anterior Cruciate Ligament Injury Using Knotless PushLock Anchors.

    PubMed

    Weninger, Patrick; Wepner, Florian; Kissler, Florian; Enenkel, Michael; Wurnig, Christian

    2015-02-01

    Direct anterior cruciate ligament (ACL) repair has been described with different suture techniques after acute ACL injury, but these procedures showed high failure rates. Recent studies, however, led to a better understanding of the biology of primary ACL healing. This article describes a novel technique combining the "healing response technique" with primary anatomic double-bundle ACL reinsertion after an acute proximal ACL tear using nonabsorbable No. 2 FiberWire (Arthrex, Naples, FL) and PushLock knotless suture anchors (Arthrex). We recommend this technique for patients with acute proximal avulsion-type ACL injuries. Postoperatively, we recommend a knee brace locked in full extension for at least 4 weeks to ensure adequate immobilization and then to increase knee flexion slowly over the next 4 weeks for subsequent healing of the ACL repair. Our technique combines anatomic positioning and reinsertion of the ACL bundles with microfracturing of the region delivering stem cells and growth factors to the repaired ACL, creating optimal conditions for the healing period. In certain cases this technique might be an alternative to conventional ACL reconstruction with autograft or allograft tendons. PMID:25973366

  18. Smaller Anterior Cruciate Ligament Diameter Is a Predictor of Subjects Prone to Ligament Injuries: An Ultrasound Study

    PubMed Central

    Mahajan, Parag Suresh; Negi, Vidya Chander; Jayaram, Abhilash Pullincherry; Hussein, Sheik Akbar

    2015-01-01

    Purpose. To test if diameter of normal anterior cruciate ligament (ACL) can be measured by ultrasound (US), to see if there is a relationship between smaller ACL diameter and ACL injury, and to assess agreement between radiologists in measuring ACL diameter in cases and matched controls. Materials and Methods. In this ethics committee-approved study, maximum diameter of ACL near tibial insertion site was measured by static and dynamic US study in 25 normal contralateral knees of subjects who suffered noncontact ACL injury and in 25 matched control subjects. Results. ACL was visualized as a thick linear hypoechoic band inserted approximately 11?mm caudal to the tibial plateau and the intercondylar eminence. Maximum diameter of contralateral ACL near tibial insertion site among injured subjects was significantly smaller than in noninjured subjects (0.62?±?0.07?cm versus 0.81?±?0.06?cm; P < 0.0001). In the regression analysis, the diameter of ACL near tibial insertion site was found significantly proportional to body weight and not significantly associated to height, gender, and age. Conclusion. Diameter of normal ACL near tibial insertion site can be measured by US and the maximum diameter is significantly smaller among subjects with noncontact ACL injury. US is a promising modality that can be used as an excellent screening test to detect subjects especially aspiring athletes prone to ACL injury. Very strong agreement was observed between radiologists in measuring ACL diameter. PMID:25685812

  19. Anterior cruciate ligament reconstruction in a rabbit model using silk-collagen scaffold and comparison with autograft.

    PubMed

    Bi, Fanggang; Shi, Zhongli; Liu, An; Guo, Peng; Yan, Shigui

    2015-01-01

    The objective of the present study was to perform an in vivo assessment of a novel silk-collagen scaffold for anterior cruciate ligament (ACL) reconstruction. First, a silk-collagen scaffold was fabricated by combining sericin-extracted knitted silk fibroin mesh and type I collagen to mimic the components of the ligament. Scaffolds were electron-beam sterilized and rolled up to replace the ACL in 20 rabbits in the scaffold group, and autologous semitendinosus tendons were used to reconstruct the ACL in the autograft control group. At 4 and 16 weeks after surgery, grafts were retrieved and analyzed for neoligament regeneration and tendon-bone healing. To evaluate neoligament regeneration, H&E and immunohistochemical staining was performed, and to assess tendon-bone healing, micro-CT, biomechanical test, H&E and Russell-Movat pentachrome staining were performed. Cell infiltration increased over time in the scaffold group, and abundant fibroblast-like cells were found in the core of the scaffold graft at 16 weeks postoperatively. Tenascin-C was strongly positive in newly regenerated tissue at 4 and 16 weeks postoperatively in the scaffold group, similar to observations in the autograft group. Compared with the autograft group, tendon-bone healing was better in the scaffold group with trabecular bone growth into the scaffold. The results indicate that the silk-collagen scaffold has considerable potential for clinical application. PMID:25938408

  20. Interdisciplinary Management of Deep Vein Thrombosis During Rehabilitation of Acute Rupture of the Anterior Cruciate Ligament: A Case Report

    PubMed Central

    Reckelhoff, Kenneth E.; Miller, Anthony

    2014-01-01

    Objective The purpose of this case report is to describe a patient who experienced deep venous thrombosis (DVT) during pre-operative rehabilitation of an acute rupture of an anterior cruciate ligament (ACL) reconstruction graft, to increase awareness of DVT occurring in a healthy individual after periodic immobilization, and to describe the interdisciplinary management for this patient. Clinical features A 30-year-old male was referred to a chiropractic clinic for presurgical treatment of a left ACL rupture and medial meniscus tear confirmed at magnetic resonance imaging. During the course of preoperative rehabilitation, the patient became limited in ambulation and presented for a routine rehabilitation visit. During this visit, he experienced increased leg swelling, pain and tenderness. The patient was assessed for DVT and was referred to the local emergency department for further evaluation where multiple DVTs were found in the left popliteal, posterior tibial, and peroneal veins. Intervention/outcome The patient was treated with a 17-week course of warfarin during which time the clinical signs and symptoms of DVT resolved. Meanwhile, the patient completed the rehabilitation treatment plan in preparation for ACL reconstruction without further complications. Conclusions This case raises awareness that DVT may occur in a healthy individual after periodic immobilization. While there may be controversy regarding the appropriate application of pharmaceutical anticoagulants in patients with DVT of the leg, the most risk averse strategy is for a short duration prescription medication with compression stockings. Through interdisciplinary management, the patient experienced a successful outcome. PMID:25685121

  1. Assessment of functional impairment after knee anterior cruciate ligament reconstruction using cardiorespiratory parameters: a cross-sectional study

    PubMed Central

    2014-01-01

    Background A dynamic sub-maximum exercise with the same absolute intensity, performed with different muscle groups, may present exacerbated cardiorespiratory responses. Therefore, cardiorespiratory responses to unilateral exercise may identify bilateral differences. The purpose of this study was to verify whether the cardiorespiratory responses to lower limb exercise display counter-lateral differences, and if they could be used to assist athletes and health professionals involved in rehabilitation. Methods Nine individuals participated in this cross-sectional study. They had been treated in a private rehabilitation clinic and submitted to intra-articular reconstruction of the anterior cruciate ligament. The cycling exercise with the same sub-maximal intensity and with one lower limb was used to gather data. Cardiorespiratory responses to exercise were compared between exercises performed with the involved and uninvolved limb after five minutes of exercise. Results Cardiorespiratory responses to exercise performed with the involved limb presented higher values after five minutes of cycling: oxygen uptake (+7%), carbon dioxide production (+10%), minute ventilation (+20%), breathing frequency (+19%), ventilatory equivalent for oxygen (+14%), end-tidal pressure of O2 oxygen (+4%), end-tidal pressure of O2 carbon dioxide (-9%) and heart rate (+9%). Conclusions The exacerbated responses, including increase of the ventilatory equivalent and decrease of end-tidal pressure of carbon dioxide, indicate that this exercise protocol may be useful in the characterization of the functional deficit of the surgical limb during rehabilitation. PMID:24885115

  2. Comparison of hamstring muscle behavior for anterior cruciate ligament (ACL) patient and normal subject during local marching

    NASA Astrophysics Data System (ADS)

    Amineldin@Aminudin, Nurul Izzaty Bt.; Rambely, A. S.

    2014-09-01

    This study aims to investigate the hamstring muscle activity after the surgery by carrying out an electromyography experiment on the hamstring and to compare the behavior of the ACL muscle activity between ACL patient and control subject. Electromyography (EMG) is used to study the behavior of muscles during walking activity. Two hamstring muscles involved which are semitendinosus and bicep femoris. The EMG data for both muscles were recorded while the subject did maximum voluntary contraction (MVC) and marching. The study concluded that there were similarities between bicep femoris of the ACL and control subjects. The analysis showed that the biceps femoris muscle of the ACL subject had no abnormality and the pattern is as normal as the control subject. However, ACL patient has poor semitendinosus muscle strength compared to that of control subject because the differences of the forces produced. The force of semitendinosus value for control subject was two times greater than that of the ACL subject as the right semitendinosus muscle of ACL subject was used to replace the anterior cruciate ligament (ACL) that was injured.

  3. Delayed intra-articular migration of the IntraFix outer sheath after anterior cruciate ligament reconstruction: a case report.

    PubMed

    Lee, Kee-Byung; Song, Si Young; Paik, Sang Hoon; Shin, Won Hyoung

    2011-10-01

    We describe a case of foreign body synovitis caused by delayed intra-articular migration of the outer sheath 5 months after anterior cruciate ligament (ACL) reconstruction with a quadrupled tibialis allograft tendon using the IntraFix device for tibial fixation. The postoperative course was unremarkable. At 5 months after surgery, the patient experienced a sudden catching sensation and a slight pain without any obvious twisting or trauma. At 6 months after surgery, extension deficit was 20°. At arthroscopy, intra-articular migration of the outer sheath from the tibial tunnel and reactive synovitis were observed. The outer sheath in the joint and the inner screw in the tibial tunnel were removed successfully. The ACL graft was well incorporated under good tension. Patient was able to return to her previous level of all daily activities with no further episodes of swelling. To our knowledge, described here is the only case of foreign body synovitis due to intra-articular migration of the unbroken sheath. PMID:20800499

  4. Loss of Extracellular Matrix from Articular Cartilage is Mediated by the Synovium and Ligament after Anterior Cruciate Ligament Injury

    PubMed Central

    Haslauer, Carla M.; Elsaid, Khaled A.; Fleming, Braden C.; Proffen, Benedikt L.; Johnson, Victor M.; Murray, Martha M.

    2014-01-01

    Objective Post-traumatic osteoarthritis (PTOA) occurs after anterior cruciate ligament (ACL) injury. PTOA may be initiated by early expression of proteolytic enzymes capable of causing degradation of the articular cartilage at time of injury. This study investigated the production of three of these key proteases in multiple joint tissues after ACL injury and subsequent markers of cartilage turnover. Design ACL transection was performed in adolescent minipigs. Collagenase (MMP-1 and MMP-13) and aggrecanase (ADAMTS-4) gene expression changes were quantified in the articular cartilage, synovium, injured ligament, and the provisional scaffold at days 1, 5, 9, and 14 post-injury. Markers of collagen degradation (C2C), synthesis (CPII) and aggrecan synthesis (CS846) were quantified in the serum and synovial fluid. Histologic assessment of the cartilage integrity (OARSI scoring) was also performed. Results MMP-1 gene expression was upregulated in the articular cartilage, synovium and ligament after ACL injury. MMP-13 expression was suppressed in the articular cartilage, but upregulated 100fold in the synovium and ligament. ADAMTS-4 was upregulated in the synovium and ligament but not in the articular cartilage. The concentration of collagen degradation fragments (C2C) in the synovial joint fluid nearly doubled in the first five days after injury. Conclusion We conclude that upregulation of genes coding for proteins capable of degrading cartilage ECM is seen within the first few days after ACL injury, and this response is seen not only in chondrocytes, but also in cells in the synovium, ligament and provisional scaffold. PMID:24036379

  5. Three dimensional anatomy of the anterior cruciate ligament: a new approach in anatomical orthopedic studies and a literature review

    PubMed Central

    Arliani, Gustavo Gonçalves; Astur, Diego Costa; Moraes, Eduardo Ramalho; Kaleka, Camila Cohen; Jalikjian, Wahi; Golano, Pau; Cohen, Moisés

    2012-01-01

    Background The anterior cruciate ligament (ACL) is an important structure in the knee. The ACL does not heal following lesions, and surgical reconstruction is the standard treatment among athletes. Some steps of ACL reconstruction remain controversial. It is important to fully understand the anatomy of the ACL to accurately reproduce its anatomy during surgical reconstructions. The purpose of this study was to evaluate the use of anaglyphic images that produce 3D images to better visualize the anatomy of the ACL, and to highlight the anatomical features of this ligament as reported in the literature. Methods We included ten knees in this study. After dissection of the knee structures, pictures were acquired using a camera with Nikon D40, AF-S Nikkor 18–55 mm (1:3.5–5.6 G2 ED), and Micro Nikkor 105 mm (1:2.8) lenses. The pair of images was processed using Callipyan 3D Anabuilder software, which transforms the two images into one anaglyphic image. Results During the dissection of the knees, nine pictures were acquired and transformed into anaglyphic images. Conclusion This study, demonstrated that the use of 3D images is a useful tool that can improve the knowledge of the anatomy of the knee, while also facilitating knee reconstruction surgery. PMID:24198601

  6. Identification of differential pattern of protein expression in canine osteoarthritis serum after anterior cruciate ligament transection: a proteomic analysis.

    PubMed

    Gharbi, M; Sanchez, C; Mazzucchelli, G; De Pauw, E; Henrotin, Y

    2013-09-01

    Osteoarthritis (OA) management remains a great challenge and there is considerable effort to understand its pathophysiology and to identify new therapeutic targets and biomarkers. Canine OA surgically induced by the transection of the anterior cruciate ligament (ACLT) is a widely used and relevant model. This study reports a proteome mapping of dog serum and an analysis of the differentially expressed proteins between before and after ACLT. In the first part of the study, 261 picked protein spots were identified from preparative 2D gels and 71 different proteins were identified among the 261 spots present on the reference map. Canine serum proteome mapping reveals the presence of proteins of interest, such as fetuin B, complement C3 and C1s and pregnancy zone protein. The comparison between serum from dogs before and after ACLT reveals the differential expression of several proteins that could play a key role in the pathogenesis of OA. A number of proteins, such as fetuin B and complement C3, were increased in dog OA serum whereas others, such as hyaluronan binding protein 2, inter-alpha-trypsin inhibitor H4 (ITIH4), complement C1s and C4 and haptoglobin were decreased. Some of these proteins could be candidate biomarkers for diagnosis, prognosis and treatment evaluation. The results of the study also reinforced the similarities between dog experimental OA and human cases of OA. PMID:23831215

  7. All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Surgical Technique Using a Split Tibial Tunnel

    PubMed Central

    Lykissas, Marios G.; Nathan, Senthil T.; Wall, Eric J.

    2012-01-01

    Many techniques have been described for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, including extra-articular, complete or partial transphyseal, and physeal-sparing techniques. An all-epiphyseal technique places the tendon and its tunnels and fixation all within the child's epiphysis, leaving the growth plates untouched. We describe an all-epiphyseal quadruple-hamstring ACL reconstruction using a split tibial tunnel. The split tibial tunnels drop the tunnel size down to 4.5 to 5.5 mm from 7 to 8 mm because only half the total graft diameter passes through each of the split tunnels. This increases the safety margin for keeping the tunnel within the tibial epiphysis, in addition to avoiding damage into the growth plate. The bone bridge between the 2 tunnels serves as a solid low-profile fixation post. Femoral graft fixation is achieved with an interference screw, which allows precise tensioning and low-profile fixation entirely within the femoral tunnel. By placing the graft at the native ACL's anatomic attachment points without spanning or violating the growth plates at any step of the procedure, an all-epiphyseal ACL reconstruction with a split tibial tunnel theoretically minimizes the risk of growth disturbance in an ACL-deficient child. PMID:23766968

  8. Biomechanical and neuromuscular characteristics of male athletes: implications for the development of anterior cruciate ligament injury prevention programs.

    PubMed

    Sugimoto, Dai; Alentorn-Geli, Eduard; Mendiguchía, Jurdan; Samuelsson, Kristian; Karlsson, Jon; Myer, Gregory D

    2015-06-01

    Prevention of anterior cruciate ligament (ACL) injury is likely the most effective strategy to reduce undesired health consequences including reconstruction surgery, long-term rehabilitation, and pre-mature osteoarthritis occurrence. A thorough understanding of mechanisms and risk factors of ACL injury is crucial to develop effective prevention programs, especially for biomechanical and neuromuscular modifiable risk factors. Historically, the available evidence regarding ACL risk factors has mainly involved female athletes or has compared male and female athletes without an intra-group comparison for male athletes. Therefore, the principal purpose of this article was to review existing evidence regarding the investigation of biomechanical and neuromuscular characteristics that may imply aberrant knee kinematics and kinetics that would place the male athlete at risk of ACL injury. Biomechanical evidence related to knee kinematics and kinetics was reviewed by different planes (sagittal and frontal/coronal), tasks (single-leg landing and cutting), situation (anticipated and unanticipated), foot positioning, playing surface, and fatigued status. Neuromuscular evidence potentially related to ACL injury was reviewed. Recommendations for prevention programs for ACL injuries in male athletes were developed based on the synthesis of the biomechanical and neuromuscular characteristics. The recommendations suggest performing exercises with multi-plane biomechanical components including single-leg maneuvers in dynamic movements, reaction to and decision making in unexpected situations, appropriate foot positioning, and consideration of playing surface condition, as well as enhancing neuromuscular aspects such as fatigue, proprioception, muscle activation, and inter-joint coordination. PMID:25663251

  9. The Kinematic Control During the Backward Gait and Knee Proprioception: Insights from Lesions of the Anterior Cruciate Ligament

    PubMed Central

    Viggiano, Davide; Corona, Katia; Cerciello, Simone; Vasso, Michele; Schiavone-Panni, Alfredo

    2014-01-01

    An already existing large volume of work on kinematics documents a reduction of step length during unusual gaits, such as backward walking. This is mainly explained in terms of modifications of some biomechanical properties. In the present study, we propose that the proprioceptive information from the knee may be involved in this change of motor strategy. Specifically, we show that a non-automated condition such as backward walking can elicit different motor strategies in subjects with reduced proprioceptive feedback after anterior cruciate ligament lesion (ACL). For this purpose, the kinematic parameters during forward and backward walking in subjects with ACL deficit were compared to two control groups: a group with intact ACL and a group with surgically reconstructed ACL. The knee proprioception was tested measuring the threshold for detection of passive knee motion. Subjects were asked to walk on a level treadmill at five different velocities (1–5km/h) in forward and backward direction, thereby calculating the cadence and step length. Results showed that forward walking parameters were largely unaffected in subjects with ACL damage. However, they failed to reduce step length during backward walking, a correction that was normally observed in all control subjects and in subjects with normal proprioceptive feedback after ACL reconstruction. The main result of the present study is that knee proprioception is an important signal used by the brain to reduce step length during the backward gait. This can have a significant impact on clinical evaluation and rehabilitation. PMID:25114731

  10. Differences in Selected Predictors of Anterior Cruciate Ligament Tears Between Male and Female NCAA Division I Collegiate Basketball Players

    PubMed Central

    Moul, Jamie L.

    1998-01-01

    Objective: To examine sex differences in strength, Q-angle, and pronation as predictors of anterior cruciate ligament (ACL) injuries. Design and Setting: Height, weight, sum-of-seven skin-folds, quadriceps and hamstrings strength, Q-angle, and pronation were measured in each subject. Subjects: Male (n = 23) and female (n = 25) NCAA Division in identical conditioning programs. Measurements: Strength was measured at 180°·s-1 using an isokinetic dynamometer. Q-angle was assessed with the leg fully extended and flexed to 30°. Pronation was determined with the navicular drop test. Results: A 2 × 2 factorial analysis of variance indicated significant differences in the eccentric hamstrings-to-eccentric quadriceps strength ratio (female right = 46.11% ± 2.83%, left = 52.73% ± 3.74%; male right = 89.08% ± 6.34%, left = 93.16% ± 9.14% (P < .001)) and Q-angle measured in 30° of flexion (female right = 13.37° ± 0.99°, left 15.56° ± 1.34°; male right = 5.62° ± 0.75°, left = 6.00° ± 0.86° (P = .05)). Conclusions: The results of this investigation indicate that, of the variables thought to contribute to ACL injuries, eccentric hamstrings strength relative to concentric quadriceps strength and Q-angle measured in 30° of flexion appear to be significantly different in males and females. PMID:16558497

  11. Performance on the modified star excursion balance test at the time of return to sport following anterior cruciate ligament reconstruction.

    PubMed

    Clagg, Sarah; Paterno, Mark V; Hewett, Timothy E; Schmitt, Laura C

    2015-06-01

    Study Design Cross-sectional. Objectives To compare performance on the modified Star Excursion Balance Test (SEBT) between participants with anterior cruciate ligament reconstruction (ACLR) at the time of return to sport and uninjured control participants. Background The modified SEBT is a clinical tool to assess neuromuscular control deficits. Deficits in dynamic stability and neuromuscular control persist after ACLR, but assessment with the modified SEBT in this population at the time of return to sport has not been reported. Methods Sixty-six participants (mean age, 17.6 years) at the time of return to sport following unilateral primary ACLR (ACLR group) and 47 uninjured participants (mean age, 17.0 years) serving as a control group participated. For the modified SEBT, the anterior, posteromedial, and posterolateral reach distances were recorded. Lower extremity muscle strength was quantified with isokinetic dynamometry. Independent-sample t tests were used to evaluate performance differences between the ACLR group and the control group and between the ACLR subgroups. In the ACLR group, bivariate correlations determined the association of modified SEBT performance with time since surgery and lower extremity muscle strength. Results The ACLR group had lower anterior reach distances on the involved and uninvolved limbs compared to the control group. There were no differences observed between groups in reach distances for the posteromedial and posterolateral directions or in limb symmetry indices for any of the reach directions. In the ACLR group, time from surgery and meniscal status at the time of ACLR did not influence modified SEBT performance, whereas participants with patellar bone-tendon-bone grafts had a lower posterolateral reach distance compared to those with hamstring grafts. In the ACLR group, involved-limb hip abduction strength positively correlated with all reach distances, and quadriceps strength positively correlated with posterolateral reach. Conclusion At the time of return to sport, participants post-ACLR demonstrated reduced modified SEBT anterior reach in both involved and uninvolved limbs compared to uninjured participants, with no other group differences. In the ACLR group, modified SEBT reach distance was associated with lower extremity muscle strength, but not with time from reconstruction or meniscal status at the time of ACLR. Lower extremity muscle strength and graft type may interact to influence modified SEBT posterior reach performance, but this requires further study. Level of Evidence Prognosis, level 2b-. J Orthop Sports Phys Ther 2015;45(6):444-452. Epub 21 Apr 2015. doi:10.2519/jospt.2015.5040. PMID:25899211

  12. Jump-Landing Biomechanics and Knee-Laxity Change Across the Menstrual Cycle in Women With Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Bell, David R.; Blackburn, J. Troy; Hackney, Anthony C.; Marshall, Stephen W.; Beutler, Anthony I.; Padua, Darin A.

    2014-01-01

    Context: Of the individuals able to return to sport participation after an anterior cruciate ligament(ACL) injury, up to 25% will experience a second ACL injury. This population may be more sensitive to hormonal fluctuations, which may explain this high rate of second injury. Objective: To examine changes in 3-dimensional hip and knee kinematics and kinetics during a jump landing and to examine knee laxity across the menstrual cycle in women with histories of unilateral noncontact ACL injury. Design ?Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 20 women (age = 19.6 ± 1.3 years, height = 168.6 ± 5.3 cm, mass = 66.2 ± 9.1 kg) with unilateral, noncontact ACL injuries. Intervention(s) Participants completed a jump-landing task and knee-laxity assessment 3 to 5 days after the onset of menses and within 3 days of a positive ovulation test. Main Outcome Measure(s): Kinematics in the uninjured limb at initial contact with the ground during a jump landing, peak kinematics and kinetics during the loading phase of landing, anterior knee laxity via the KT-1000, peak vertical ground reaction force, and blood hormone concentrations (estradiol-?-17, progesterone, free testosterone). Results: At ovulation, estradiol-?-17 (t = ?2.9, P = .009), progesterone (t = ?3.4, P = .003), and anterior knee laxity (t = ?2.3, P = .03) increased, and participants presented with greater knee-valgus moment (Z = ?2.6, P = .01) and femoral internal rotation (t = ?2.1, P = .047). However, during the menses test session, participants landed harder (greater peak vertical ground reaction force; t = 2.2, P = .04), with the tibia internally rotated at initial contact (t = 2.8, P = .01) and greater hip internal-rotation moment (Z = ?2.4, P = .02). No other changes were observed across the menstrual cycle. Conclusions Knee and hip mechanics in both phases of the menstrual cycle represented a greater potential risk of ACL loading. Observed changes in landing mechanics may explain why the risk of second ACL injury is elevated in this population. PMID:24568229

  13. The role of the lateral extraarticular restraints in the anterior cruciate ligament-deficient knee

    Microsoft Academic Search

    Randall R. Wroble; Edward S. Grood; John S. Cummings; Joel M. Henderson; Frank R. Noyes

    1993-01-01

    We measured the increases in tibiofemoral motion when lateral structures were sectioned in anterior cru ciate ligament-deficient knees of 20 unembalmed ca daveric whole lower limbs. Motion was measured with a six degrees-of-freedom electrogoniometer. The lateral structures investigated were the iliotibial band and mid- lateral capsule, lateral collateral ligament, and popliteus tendon and the posterolateral capsule.Cutting the anterolateral structures increased

  14. Effect of meniscal loss on knee stability after single-bundle anterior cruciate ligament reconstruction

    Microsoft Academic Search

    Frank A. Petrigliano; Volker Musahl; Eduardo M. Suero; Musa Citak; Andrew D. Pearle

    Purpose  The menisci are known to be important secondary constraints to anterior translation of the tibia in the ACL-deficient knee.\\u000a The effect of meniscal loss on knee stability as measured by the magnitude of the pivot shift following ACL reconstruction\\u000a is unknown. The objective of this investigation was to determine the effect of meniscectomy on knee stability following two\\u000a single-bundle ACL

  15. Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation

    PubMed Central

    Wright, Rick W.; Ross, James R.; Haas, Amanda K.; Huston, Laura J.; Garofoli, Elizabeth A.; Harris, David; Patel, Kushal; Pearson, David; Schutzman, Jake; Tarabichi, Majd; Ying, David; Albright, John P.; Allen, Christina R.; Amendola, Annunziato; Anderson, Allen F.; Andrish, Jack T.; Annunziata, Christopher C.; Arciero, Robert A.; Bach, Bernard R.; Baker, Champ L.; Bartolozzi, Arthur R.; Baumgarten, Keith M.; Bechler, Jeffery R.; Berg, Jeffrey H.; Bernas, Geoffrey A.; Brockmeier, Stephen F.; Brophy, Robert H.; Bush-Joseph, Charles A.; Butler V, J. Brad; Campbell, John D.; Carpenter, James E.; Cole, Brian J.; Cooper, Daniel E.; Cooper, Jonathan M.; Cox, Charles L.; Creighton, R. Alexander; Dahm, Diane L.; David, Tal S.; DeBerardino, Thomas M.; Dunn, Warren R.; Flanigan, David C.; Frederick, Robert W.; Ganley, Theodore J.; Gatt, Charles J.; Gecha, Steven R.; Giffin, James Robert; Hame, Sharon L.; Hannafin, Jo A.; Harner, Christopher D.; Harris, Norman Lindsay; Hechtman, Keith S.; Hershman, Elliott B.; Hoellrich, Rudolf G.; Hosea, Timothy M.; Johnson, David C.; Johnson, Timothy S.; Jones, Morgan H.; Kaeding, Christopher C.; Kamath, Ganesh V.; Klootwyk, Thomas E.; Lantz, Brett A.; Levy, Bruce A.; Ma, C. Benjamin; Maiers, G. Peter; Mann, Barton; Marx, Robert G.; Matava, Matthew J.; Mathien, Gregory M.; McAllister, David R.; McCarty, Eric C.; McCormack, Robert G.; Miller, Bruce S.; Nissen, Carl W.; O’Neill, Daniel F.; Owens, LTC Brett D.; Parker, Richard D.; Purnell, Mark L.; Ramappa, Arun J.; Rauh, Michael A.; Rettig, Arthur; Sekiya, Jon K.; Shea, Kevin G.; Sherman, Orrin H.; Slauterbeck, James R.; Smith, Matthew V.; Spang, Jeffrey T.; Spindler, Kurt P.; Stuart, Michael J.; Svoboda, LTC Steven J.; Taft, Timothy N.; Tenuta, COL Joachim J.; Tingstad, Edwin M.; Vidal, Armando F.; Viskontas, Darius G.; White, Richard A.; Williams, James S.; Wolcott, Michelle L.; Wolf, Brian R.; York, James J.; Carey, James L.

    2014-01-01

    Background: Osteoarthritis of the knee is commonly diagnosed and monitored with radiography. However, the reliability of radiographic classification systems for osteoarthritis and the correlation of these classifications with the actual degree of confirmed degeneration of the articular cartilage of the tibiofemoral joint have not been adequately studied. Methods: As the Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) Group, we conducted a multicenter, prospective longitudinal cohort study of patients undergoing revision surgery after anterior cruciate ligament reconstruction. We followed 632 patients who underwent radiographic evaluation of the knee (an anteroposterior weight-bearing radiograph, a posteroanterior weight-bearing radiograph made with the knee in 45° of flexion [Rosenberg radiograph], or both) and arthroscopic evaluation of the articular surfaces. Three blinded examiners independently graded radiographic findings according to six commonly used systems—the Kellgren-Lawrence, International Knee Documentation Committee, Fairbank, Brandt et al., Ahlbäck, and Jäger-Wirth classifications. Interobserver reliability was assessed with use of the intraclass correlation coefficient. The association between radiographic classification and arthroscopic findings of tibiofemoral chondral disease was assessed with use of the Spearman correlation coefficient. Results: Overall, 45° posteroanterior flexion weight-bearing radiographs had higher interobserver reliability (intraclass correlation coefficient = 0.63; 95% confidence interval, 0.61 to 0.65) compared with anteroposterior radiographs (intraclass correlation coefficient = 0.55; 95% confidence interval, 0.53 to 0.56). Similarly, the 45° posteroanterior flexion weight-bearing radiographs had higher correlation with arthroscopic findings of chondral disease (Spearman rho = 0.36; 95% confidence interval, 0.32 to 0.39) compared with anteroposterior radiographs (Spearman rho = 0.29; 95% confidence interval, 0.26 to 0.32). With respect to standards for the magnitude of the reliability coefficient and correlation coefficient (Spearman rho), the International Knee Documentation Committee classification demonstrated the best combination of good interobserver reliability and medium correlation with arthroscopic findings. Conclusions: The overall estimates with the six radiographic classification systems demonstrated moderate (anteroposterior radiographs) to good (45° posteroanterior flexion weight-bearing radiographs) interobserver reliability and medium correlation with arthroscopic findings. The International Knee Documentation Committee classification assessed with use of 45° posteroanterior flexion weight-bearing radiographs had the most favorable combination of reliability and correlation. Level of Evidence: Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence. PMID:25031368

  16. Anterior Cruciate Ligament Reconstruction Using Achilles Tendon Allograft: an Assessment of Outcome for Patients Age 30 Years and Older

    PubMed Central

    Chehab, Eric L.; Flik, Kyle R.; Vidal, Armando F.; Levinson, Michael; Altchek, David W.; Warren, Russell F.

    2010-01-01

    Achilles allografts have become popular for anterior cruciate ligament (ACL) reconstructions in older patients. Primary ACL reconstructions using Achilles tendon allografts in patients age 30 years and older are successful in restoring the knee to “normal” or “near normal.” During a three-year period, the two senior authors performed 65 primary ACL reconstructions using Achilles tendon allografts in patients aged 30 years and older. Our exclusion criteria were periarticular fracture, ipsilateral/contralateral knee ligament injury, and previous or concomitant osteotomy or cartilage restoration procedure. Each patient was evaluated via physical examination, functional and arthrometric testing, and radiographic and subjective outcome. Knees were considered normal, near normal, or abnormal based on the International Knee Documentation Committee (IKDC) system. Forty-three patients were examined at an average of 33 months (minimum, 24 months) postoperatively. At the time of ACL reconstruction, 35% had normal articular cartilage in all three compartments and 70% had meniscal tears. No re-ruptures occurred. While 24% had mean maximal translation differences less than or equal to 3 mm, none had side-to-side differences greater than 5 mm. Postoperative IKDC, Activities of Daily Living, and Activity Rating Scale scores averaged 88, 94, and 7.7, respectively. Despite the overall favorable outcomes, 29% had worsened radiographic grades at follow-up. Using an Achilles allograft for ACL reconstruction in patients older than 30 years, we restored over 90% of knees to normal or near normal while limiting postoperative complications. Poor subjective results may be related less to instability and more to pain, which may result from progressive arthritis. PMID:22294957

  17. Reconstruction of the anterior cruciate ligament: a comparison between bone-patellar tendon-bone grafts and fourstrand hamstring grafts

    PubMed Central

    Razi, Mohammad; Sarzaeem, Mohammad Mahdi; Kazemian, Gholam Hossein; Najafi, Farideh; Najafi, Mohammad Amin

    2014-01-01

    Background: Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The choice of graft for (ACL) reconstruction remains controversial. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (ST) grafts for ACL reconstruction over a 3-year follow-up interval. Methods: Seventy-one patients with an average age of 29± 4.5yearswere treated for torn ACL between 2008 and 2009. Forty-sixpatients underwent reconstruction with BPTB autograft, and 41 were treated with ST autograft. At the time of final follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC (International Knee Documentation Committee) score and complications. Results: At 36thmonth of follow-up, 34 (92%) and 28 (82%) patients in BPTB and ST group, respectively had good-to-excellent IKDC score (p > 0.05). The activity levels were higher in BPTB group (p> 0.05). At 3rd yearof follow up, the Lachman test was graded normal, for 23 (62%) and 11 (32%) patients in BPTB and ST group, respectively (p=0.019). Regarding the pivot-shift test, 29 (79%) and 15 (44%) patients in patella and hamstring group, respectively had normal test at the latest follow-up (p=0.021).There were no significant differences in terms of thigh circumference difference, effusion, knee range of motion, pain and complications. Conclusion: The results indicate a trend toward increased graft laxity and pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level and knee function. PMID:25694992

  18. Effect of Anteromedial Portal Entrance Drilling Angle during Anterior Cruciate Ligament Reconstruction: A Three-Dimensional Computer Simulation

    PubMed Central

    Moon, Dong Kyu; Yoon, Chul Ho; Park, Jin Seung; Kang, Bun Jung; Cho, Seong Hee; Jo, Ho Seung

    2014-01-01

    Purpose The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation. Materials and Methods Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured. Results In tunnels drilled at a coronal angle of 45°, an axial angle of 45°, and a sagittal angle of 45°, the mean femoral tunnel length was 39.5±3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4±2.6 mm. The tunnel length at a coronal angle of 30°, an axial angle of 60°, and a sagittal angle of 45°, was 34.0±2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7±1.3 mm, which was significantly shorter than the standard angle (p<0.001). Conclusion Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal. PMID:25323895

  19. Good results five years after surgical management of anterior cruciate ligament tears, and meniscal and cartilage injuries.

    PubMed

    Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Amato, Cirino; Denaro, Vincenzo; Maffulli, Nicola

    2010-10-01

    In athletes with anterior cruciate ligament (ACL) tears combined with meniscal and cartilage injuries, the goals are to restore knee laxity and relieve symptoms, while long-term goals are the return to pre-injury sport activity and to prevent onset of degenerative changes. We compared the post-operative (minimum 5 years) clinical and radiological outcomes of 50 patients, similar for ACL rupture and meniscal tears, but different for the grade of cartilage lesion. The patient population was divided into two groups similar for ACL reconstruction and surgical meniscal management. Group 1 included 25 patients undergoing microfracture management of grade III-IV cartilage lesions, while Group 2 included 25 patients with grade I-II cartilage lesions, managed by radiofrequency. Comparing pre- and post-operative status, Lachman test, pivot shift values and KT 1000 side to side difference measurements improved significantly (<.001) in both groups, with NS difference between the two groups (>0.05) at the intermediate and latest assessments. At both post-operative appointments, in both groups, the average Lysholm score and IKDC ranking rates improved significantly (<0.001) compared to pre-operative values, but slight worsening was observed in Group 1 patients at the latest review. At the latest assessment, 10 knees (40%) in Group 1 and 3 knees (15%) in Group 2 demonstrated degenerative changes according to Fairbank grading. Concerning the WOMAC index score and sport activity level rating, Group 1 patients had significantly lower scores than Group 2 patients (P < 0.05). In patients with symptomatic ACL instability combined to grade III-IV cartilage lesions, microfractures give excellent short-term clinical and functional improvement but do not prevent the evolution of degenerative changes. PMID:20111955

  20. Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial

    PubMed Central

    2013-01-01

    Background Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk. Methods/Design 80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures. Discussion The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR. Trial registration Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317 PMID:23522373

  1. Overrepresentation of the COL3A1 AA genotype in Polish skiers with anterior cruciate ligament injury.

    PubMed

    St?pie?-S?odkowska, M; Ficek, K; Maciejewska-Kar?owska, A; Sawczuk, M; Zi?tek, P; Król, P; Zmijewski, P; Pokrywka, A; Ci?szczyk, P

    2015-06-01

    Although various intrinsic and extrinsic risk factors for anterior cruciate ligament (ACL) rupture have been identified, the exact aetiology of the injury is not yet fully understood. Type III collagen is an important factor in the repair of connective tissue, and certain gene polymorphisms may impair the tensile strength. The aim of this study was to examine the association of the COL3A1 rs1800255 polymorphism with ACL rupture in Polish male recreational skiers. A total of 321 male Polish recreational skiers were recruited for this study; 138 had surgically diagnosed primary ACL ruptures (ACL-injured group) and 183 were apparently healthy male skiers (control group - CON) who had no self-reported history of ligament or tendon injury. Both groups had a comparable level of exposure to ACL injury. Genomic DNA was extracted from the oral epithelial cells. All samples were genotyped on a real-time polymerase chain reaction instrument. The genotype distribution in the ACL-injured group was significantly different than in CON (respectively: AA=10.1 vs 2.2%, AG=22.5 vs 36.1, GG=67.4 vs 61.8%; p=0.0087). The AA vs AG+GG genotype of COL3A1 (odds ratio (OR)=5.05; 95% confidence interval (CI), 1.62-15.71, p=0.003) was significantly overrepresented in the ACL-injured group compared with CON. The frequency of the A allele was higher in the ACL-injured group (21.4%) compared with CON (20.2%), but the difference was not statistically significant (p=0.72). This study revealed an association between the COL3A1 rs1800255 polymorphism and ACL ruptures in Polish skiers. PMID:26060338

  2. Association Between Previous Meniscal Surgery and the Incidence of Chondral Lesions at Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Brophy, Robert H.; Wright, Rick W.; David, Tal S.; McCormack, Robert G.; Sekiya, Jon K.; Svoboda, Steven J.; Huston, Laura J.; Haas, Amanda K.; Steger-May, Karen

    2013-01-01

    Background Knees undergoing revision anterior cruciate ligament (ACL) reconstruction typically have more intra-articular injuries than do knees undergoing primary reconstruction. Hypothesis Previous partial meniscectomy (PM) is associated with a higher rate of chondral lesions at revision ACL reconstruction, whereas previous meniscal repair (MR) is not associated with a higher rate of chondral lesions at revision ACL reconstruction, compared with knees undergoing revision ACL with no previous meniscal surgery. Study design Cohort study (Prevalence); Level of evidence, 2. Methods Data from a multicenter cohort was reviewed to determine the history of prior meniscal surgery (PM/MR) and the presence of grade II/III/IV chondral lesions at revision ACL reconstruction. The association between previous meniscal surgery and the incidence of chondral lesions was examined. Patient age was included as a covariate to determine if surgery type contributes predictive information independent of patient age. Results The cohort included 725 ACL revision surgeries. Chondrosis was associated with patient age (P < .0001) and previous meniscal surgery (P < .0001). After adjusting for patient age, knees with previous PM were more likely to have chondrosis than knees with previous MR (P = .003) or no previous meniscal surgery (P < .0001). There was no difference between knees without previous meniscal surgery and knees with previous MR (P = .7). Previous partial meniscectomy was associated with a higher rate of chondrosis in the same compartment compared with knees without previous meniscal surgery (P < .0001) and knees with previous MR (P ? .03). Conclusion The status of articular cartilage at the time of revision ACL reconstruction relates to previous meniscal surgery independent of the effect of patient age. Previous partial meniscectomy is associated with a higher incidence of articular cartilage lesions, whereas previous meniscal repair is not. Although this association may reflect underlying differences in the knee at the time of prior surgery, it does suggest that meniscal repair is preferable when possible at the time of ACL reconstruction. PMID:22374942

  3. The effect of physiotherapy on knee joint extensor and flexor muscle strength after anterior cruciate ligament reconstruction using hamstring tendon

    PubMed Central

    Czamara, Andrzej; Tomaszewski, Wies?aw; Bober, Tadeusz; Lubarski, Bartosz

    2011-01-01

    Summary Background The aim of this paper is to present the physiotherapeutic program employed at the Rehabilitation Centre for the College of Physiotherapy in Wroc?aw, Poland and its effectiveness by demonstrating the increase in strength of knee joint extensor and flexor muscles of patients after anterior cruciate ligament (ACL) reconstruction. Material/Methods Thirty-seven males participated in the physiotherapeutic program from the first week up to 8 months postoperatively. Each patient underwent an individual therapeutic program. Endoscopic reconstruction of a completely ruptured ACL was performed using Mitek’s method (graft harvesting from flexor muscles). All patients previously underwent orthopedic and functional examinations, including measurements of the range of movement, knee and thigh circumference and strength of flexor and extensor muscles of the involved and uninvolved leg using a Biodex 3 System in both static and isokinetic modes. Results The outcome of the physiotherapeutic procedure, which is detailed in the paper, revealed a favorable effect of physiotherapy 6 months after ACL reconstruction. The observed 9% deficit in extensor muscle strength measured under isokinetic conditions of the involved knees compared with the uninvolved knees led us to conclude that the period of physiotherapy should be extended beyond 6 months for some patients. Conclusions 1. Six months of physiotherapy following ACL reconstruction in males favorably affected muscle strength values of the involved and uninvolved knees under static and isokinetic conditions. 2. The application of individual loads during the sixth month of physiotherapy resulted in similar values of extensor and flexor muscle strength measured under static conditions, and flexor muscle strength measured under isokinetic conditions in involved and uninvolved knees.

  4. Overrepresentation of the COL3A1 AA genotype in Polish skiers with anterior cruciate ligament injury

    PubMed Central

    Ficek, K; Maciejewska-Kar?owska, A; Sawczuk, M; Zi?tek, P; Król, P; Zmijewski, P; Pokrywka, A; Ci?szczyk, P

    2015-01-01

    Although various intrinsic and extrinsic risk factors for anterior cruciate ligament (ACL) rupture have been identified, the exact aetiology of the injury is not yet fully understood. Type III collagen is an important factor in the repair of connective tissue, and certain gene polymorphisms may impair the tensile strength. The aim of this study was to examine the association of the COL3A1 rs1800255 polymorphism with ACL rupture in Polish male recreational skiers. A total of 321 male Polish recreational skiers were recruited for this study; 138 had surgically diagnosed primary ACL ruptures (ACL-injured group) and 183 were apparently healthy male skiers (control group – CON) who had no self-reported history of ligament or tendon injury. Both groups had a comparable level of exposure to ACL injury. Genomic DNA was extracted from the oral epithelial cells. All samples were genotyped on a real-time polymerase chain reaction instrument. The genotype distribution in the ACL-injured group was significantly different than in CON (respectively: AA=10.1 vs 2.2%, AG=22.5 vs 36.1, GG=67.4 vs 61.8%; p=0.0087). The AA vs AG+GG genotype of COL3A1 (odds ratio (OR)=5.05; 95% confidence interval (CI), 1.62-15.71, p=0.003) was significantly overrepresented in the ACL-injured group compared with CON. The frequency of the A allele was higher in the ACL-injured group (21.4%) compared with CON (20.2%), but the difference was not statistically significant (p=0.72). This study revealed an association between the COL3A1 rs1800255 polymorphism and ACL ruptures in Polish skiers. PMID:26060338

  5. Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Autograft to Avoid Harvest-Site Morbidity in Knee Arthroscopy

    PubMed Central

    Koh, Eitaku; Oe, Kenichi; Takemura, Seisuke; Iida, Hirokazu

    2015-01-01

    Although anterior cruciate ligament reconstruction using a bone–patellar tendon–bone (BPTB) autograft has many advantages (e.g., high strength and solid fixation), there are also several complications (e.g., anterior knee pain or kneeling pain) due to harvest-site morbidity associated with the use of this graft type compared with the use of hamstring tendon. Therefore the ultimate goal of anterior cruciate ligament reconstruction using a BPTB graft is to minimize harvest-site morbidity. We have used a technique for harvesting central-third BPTB grafts that involves only a 3-cm-long, longitudinal, curved incision in the medial tibial tuberosity for both graft harvesting and fixation. The purpose of this report is to describe the technique, which can avoid the harvest-site morbidities associated with BPTB autografts during knee arthroscopy. We believe that this less invasive reconstruction may reduce the harvest-site morbidities associated with BPTB grafts because it allows for BPTB graft harvesting without incising the synovial bursa or paratenon and mitigates scarring and adhesion formation.

  6. Anterior Cruciate Ligament Reconstruction Using a Bone-Patellar Tendon-Bone Autograft to Avoid Harvest-Site Morbidity in Knee Arthroscopy.

    PubMed

    Koh, Eitaku; Oe, Kenichi; Takemura, Seisuke; Iida, Hirokazu

    2015-04-01

    Although anterior cruciate ligament reconstruction using a bone-patellar tendon-bone (BPTB) autograft has many advantages (e.g., high strength and solid fixation), there are also several complications (e.g., anterior knee pain or kneeling pain) due to harvest-site morbidity associated with the use of this graft type compared with the use of hamstring tendon. Therefore the ultimate goal of anterior cruciate ligament reconstruction using a BPTB graft is to minimize harvest-site morbidity. We have used a technique for harvesting central-third BPTB grafts that involves only a 3-cm-long, longitudinal, curved incision in the medial tibial tuberosity for both graft harvesting and fixation. The purpose of this report is to describe the technique, which can avoid the harvest-site morbidities associated with BPTB autografts during knee arthroscopy. We believe that this less invasive reconstruction may reduce the harvest-site morbidities associated with BPTB grafts because it allows for BPTB graft harvesting without incising the synovial bursa or paratenon and mitigates scarring and adhesion formation. PMID:26052497

  7. Comparison of transtibial and transportal techniques in drilling femoral tunnels during anterior cruciate ligament reconstruction using 3D-CAD models

    PubMed Central

    Tashiro, Yasutaka; Okazaki, Ken; Uemura, Munenori; Toyoda, Kazutaka; Osaki, Kanji; Matsubara, Hirokazu; Hashizume, Makoto; Iwamoto, Yukihide

    2014-01-01

    Purpose The purpose of this study was to assess the differences in bone tunnel apertures between the trans-accessory medial portal (trans-AMP) technique and the transtibial (TT) technique in double-bundle anterior cruciate ligament reconstruction. The extent of ovalization and the frequency of overlap of the two tunnel apertures were compared. Methods The simulation of femoral tunnel drilling with the TT and the trans-AMP techniques was performed using three-dimensional computer aided design models from two volunteers. The incidence angle of drilling against the intercondylar wall, the femoral tunnel position, the ovalization, and the overlap were analyzed. The aperture and location of the tunnels were also examined in real anterior cruciate ligament reconstruction cases (n=36). Results The surgical simulation showed that a lower drill incident angle induced by the TT technique made the apertures of two tunnels more ovalized, located anteromedial tunnels in a shallower position to prevent posterior wall blow out, and led to a higher frequency of tunnel overlap. The trans-AMP group had tunnel places within the footprint and had less ovalization and overlap. The results of analysis for tunnels in the clinical cases were consistent with results from the surgical simulation. Conclusion In the TT technique, the shallow anteromedial tunnel location and more ovalized tunnel aperture can lead to a higher frequency of tunnel overlap. Compared with the TT technique, the trans-AMP technique was more useful in preparing femoral tunnels anatomically and avoiding tunnel ovalization and overlapping in double-bundle anterior cruciate ligament reconstruction. PMID:24744615

  8. The effect of bone tunnel dilation versus extraction drilling on the initial fixation strength of press-fit anterior cruciate ligament reconstruction

    Microsoft Academic Search

    Jens Dargel; Rüdiger Schmidt-Wiethoff; Gert-Peter Brüggemann; Jürgen Koebke

    2007-01-01

    Introduction  Serial dilation of the bone tunnel has been reported to create a tighter graft-tunnel fit. It was hypothesized that a serial\\u000a dilation of the femoral bone tunnel would increase the initial fixation strength in press-fit anterior cruciate ligament (ACL)\\u000a reconstructive surgery.\\u000a \\u000a \\u000a \\u000a Materials and methods  Initial fixation strength of the femoral press-fit fixation technique was investigated in 72 porcine specimens in an

  9. In Vivo Motion of Femoral Condyles During Weight-Bearing Flexion After Anterior Cruciate Ligament Rupture Using Biplane Radiography

    PubMed Central

    Chen, Kaining; Yin, Li; Cheng, Liangjun; Li, Chuan; Chen, Cheng; Yang, Liu

    2013-01-01

    The purpose of this study was to investigate in vivo three- dimensional tibiofemoral kinematics and femoral condylar motion in knees with anterior cruciate ligament (ACL) deficiency during a knee bend activity. Ten patients with unilateral ACL rupture were enrolled. Both the injured and contralateral normal knees were imaged using biplane radiography at extension and at 15°, 30°, 60°, 90°, and 120° of flexion. Bilateral knees were next scanned by computed tomography, from which bilateral three-dimensional knee models were created. The in vivo tibiofemoral motion at each flexion position was reproduced through image registration using the knee models and biplane radiographs. A joint coordinate system containing the geometric center axis of the femur was used to measure the tibiofemoral motion. In ACL deficiency, the lateral femoral condyle was located significantly more posteriorly at extension and at 15° (p < 0.05), whereas the medial condylar position was changed only slightly. This constituted greater posterior translation and external rotation of the femur relative to the tibia at extension and at 15° (p < 0.05). Furthermore, ACL deficiency led to a significantly reduced extent of posterior movement of the lateral condyle during flexion from 15° to 60° (p < 0.05). Coupled with an insignificant change in the motion of the medial condyle, the femur moved less posteriorly with reduced extent of external rotation during flexion from 15° to 60° in ACL deficiency (p < 0.05). The medial- lateral and proximal-distal translations of the medial and lateral condyles and the femoral adduction-abduction rotation were insignificantly changed after ACL deficiency. The results demonstrated that ACL deficiency primarily changed the anterior-posterior motion of the lateral condyle, producing not only posterior subluxation at low flexion positions but also reduced extent of posterior movement during flexion from 15° to 60°. Key Points Three-dimensional tibiofemoral kinematics and femoral condylar motion in ACL-deficient knees during upright weight-bearing flexion were measured using biplane radiography with the geometric center axis. ACL deficiency caused posterior subluxation of the lateral condyle with excess external femoral rotation at early flexion positions. On flexion from 15° to 60°, the lateral condyle moved slightly posteriorly in ACL deficiency leading to reduced extent of external femoral rotation. PMID:24149168

  10. All-Inside Posterior Cruciate Ligament Reconstruction With a GraftLink

    PubMed Central

    Adler, Gerard G.

    2013-01-01

    Posterior cruciate ligament (PCL) reconstructions are challenging surgeries. Recent advances have included double-bundle PCL, arthroscopic inlay, and all-inside techniques. This technical note presents an anatomic, single-bundle, all-inside PCL reconstruction with an anterior tibialis allograft GraftLink construct. The surgery was performed with FlipCutter guide pins and ACL TightRope RT. The case involved a 22-year-old woman with an isolated grade 3 PCL tear that had failed nonoperative treatment. The technique described is minimally invasive. PMID:23875134

  11. [Troublesome radiologic changes after reconstructive fixation of the anterior cruciate ligament with resorbable interference screws].

    PubMed

    Loubignac, F; Lecuire, F; Rubini, J; Basso, M

    1998-03-01

    The authors report worrisome radiological changes which were noted after implantation of absorbable interference screws in ligamentoplasty at the knee joint. Seventeen screws were implanted between September 1995 and July 1996, in eleven patients (average age 27) who were operated upon for chronic anterior knee instability. They underwent a modified Kenneth Jones procedure using autografts with absorbable interference screws (Acufex in 2 cases and Bio-interférix in 9 cases). Significant enlargement of bone tunnels and bony sclerosis of their edges were noted in every patient, but without any modification in the positioning of the graft. No clinical instability was observed in any of the patients, with one to two years follow-up. Publications on this topic are scarce except for one author who reported enlargement of bone tunnels after using bone-patellar tendon-bone allografts. Resorption of absorbable screws probably induces a marked inflammatory reaction, with radiological changes reminiscent of those sometimes observed after tendon allografts. Although the radiological changes reported here may not affect the graft fixation, the authors have reverted to using metallic interference screws. PMID:9586250

  12. Ganglion cysts associated with cruciate ligaments of the knee: a possible cause of recurrent knee pain.

    PubMed

    García-Alvarez, F; García-Pequerul, J M; Avila, J L; Sainz, J M; Castiella, T

    2000-12-01

    Intraarticular ganglia of the knee are uncommon; however, these ganglion cysts may produce knee discomfort without a clear etiology. We present the cases of 10 patients with ganglion cysts arising from cruciate ligaments of the knee joint who underwent arthroscopic excision after MR examination. The MR findings, clinical features and arthroscopic findings were evaluated comparatively. Diagnoses were confirmed by means of a histological study after arthroscopic excision. The cysts were fluid-filled, with low T1-weighted signal intensity and high T2-weighted signal intensity. Except for two patients with recent accidents, the remaining eight presented chronic pain without any history of trauma. Pain was the most frequent clinical sign. It was associated with knee extension in 3 cases and with flexion in 3 cases. In 7 cases, cysts were exclusively associated with the anterior cruciate ligament (ACL). Only in one case was a cyst associated with an ACL rupture. Four patients presented meniscal lesions. All ganglia appeared solitary in each knee. Postarthroscopy evolution was painless in 8 patients. Histologic diagnoses corresponded to ganglion cysts. The tissues from the patient with the ACL rupture presented a fibrous reaction with myxoid degeneration forming intraligamentary ganglion cysts. PMID:11196374

  13. No difference at two years between all inside transtibial technique and traditional transtibial technique in anterior cruciate ligament reconstruction

    PubMed Central

    Volpi, Piero; Bait, Corrado; Cervellin, Matteo; Denti, Matteo; Prospero, Emanuele; Morenghi, Emanuela; Quaglia, Alessandro

    2014-01-01

    Summary Background: one of the most recent technique is the “all inside” anterior cruciate ligament (ACL) reconstruction. One of the main characteristic of this procedure is the sparing of the tibial cortex. Furthermore, the all-inside technique requires only one tendon harvested. Purpose: the present study describes two year clinical outcomes of the all-inside method for ACL reconstruction, and compares them with clinical results of a group of patients treated with the traditional transtibial single-bundle ACL reconstruction technique using the semitendinosus and gracilis tendons (ST-G). Study design: pilot study, using historical controls. Methods: ACL reconstruction was performed on two groups of 20 patients each. The patients in one group underwent the all-inside transtibial technique with ST tendon alone. The second group underwent ACL reconstruction with the traditional transtibial single-bundle procedure using quadrupled ST-G tendons. Follow up at 24 months was undertaken using the IKDC, VAS pain score, Lysholm and Tegner scales. Results: the VAS pain score for the traditional ACL group was 84.6 ± 12.6; whereas the score for the all-inside group was 81.6 ± 13.1, with no statistically significant differences between the two groups. In the traditional ACL reconstruction group the Lysholm scale gave a “good results” for 7 patient (35%) and “excellent results” for 13 patients (65%) and the all-inside group gave “sufficient results” for 4 patients (20%), “good results” for 7 patients (35%) and “excellent results” for 9 patients (45%) (n.s.). The median of Tegner score was 6.5 (2–10) for the standard method group and 6 (1–9) for the all-inside group (n.s). The IKDC evaluated 50% of patients from the standard technique group as class A, and 45% as class B and 5% as class C. As regards patients of the all inside technique 55% were class A, 40% class B and, here too, just 5% scored as class C. No patients were classed as group D in each group. Conclusions: this study suggests that, in respect to return to sports and adequate articular function, there are no differences between the all-inside transtibial ACL reconstruction technique and the traditional transtibial ACL reconstruction using ST-G. The role of all-inside transtibial ACL reconstruction remains dubious. Level of evidence: III or Level C according with Oxford Center of EBM. PMID:24932456

  14. The value of the sagittal-oblique MRI technique for injuries of the anterior cruciate ligament in the knee

    PubMed Central

    Nenezic, Dragoslav; Kocijancic, Igor

    2013-01-01

    Background Complete rupture of the anterior cruciate ligament (ACL) does not represent a diagnostic problem for the standard magnetic resonance (MR) protocol of the knee. Lower accuracy of the standard MR protocol for partial rupture of the ACL can be improved by using additional, dedicated MR techniques. The study goal was to draw a comparison between sagittal-oblique MR technique of ACL imaging versus flexion MR technique of ACL imaging and, versus ACL imaging obtained with standard MR protocol of the knee. Patients and methods In this prospective study we included 149 patients who were referred to magnetic resonance imaging (MRI) examination due to knee soft tissues trauma during 12 months period. MRI signs of ACL trauma, especially detection of partial tears, number of slices per technique showing the whole ACL, duration of applied additional protocols, and reproducibility of examination were analysed. Results Accuracy of standard MRI protocol of the knee comparing to both additional techniques is identical in detection of a complete ACL rupture. Presentations of the partial ruptures of ACL using flexion technique and sagittal-oblique technique were more sensitive (p<0.001) than presentation using standard MR protocol. There was no statistically significant difference between MRI detection of the ruptured ACL between additional techniques (p> 0.65). Sagittal-oblique technique provides a higher number of MRI slices showing the whole course of the ACL and requires a shorter scan time compared to flexion technique (p<0.001). Conclusions Both additional techniques (flexion and sagittal-oblique) are just as precise as the standard MR protocol for the evaluation of a complete rupture of the ACL, so they should be used in cases of suspicion of partial rupture of the ACL. Our study showed sagittal-oblique technique was superior, because it did not depend on patient’s ability to exactly repeat the same external rotation if standard MR protocol was used or to repeat exactly the same flexion in flexion MR technique in further MR examinations. Sagittal-oblique technique does not require the patient’s knee to be repositioned, which makes this technique faster. We propose this technique in addition to the standard MR protocol for detection of partial ACL tears. PMID:23450118

  15. Development of a strength test battery for evaluating leg muscle power after anterior cruciate ligament injury and reconstruction.

    PubMed

    Neeter, Camille; Gustavsson, Alexander; Thomeé, Pia; Augustsson, Jesper; Thomeé, Roland; Karlsson, Jon

    2006-06-01

    A more sports-specific and detailed strength assessment has been advocated for patients after anterior cruciate ligament (ACL) injury and reconstruction. The purpose of this study was to develop a test battery of lower extremity strength tests with high ability to discriminate between leg power development on the injured and uninjured sides in patients after ACL injury and in patients who have undergone ACL reconstruction. Twenty-three patients were tested 6 months after ACL injury and 44 patients were tested 6 months after ACL reconstruction. Twenty-four of the 44 patients were operated on using a hamstrings graft and 20 patients were operated on using a patellar tendon graft. All the patients performed a test battery of three strength tests for each leg in a randomised order. The three strength tests were chosen to reflect quadriceps and hamstring muscular power in a knee-extension and a knee-flexion test (open kinetic chain) and lower-extremity muscular power in a leg-press test (closed kinetic chain). There was a higher sensitivity for the test battery to discriminate abnormal leg power compared with any of the three strength tests individually. Nine out of ten patients after ACL reconstruction and six out of ten of the patients after ACL injury exhibited abnormal leg power symmetry using the test battery. Thus, this test battery had high ability in terms of discriminating between the leg power performance on the injured and uninjured side, both in patients with an ACL injury and in patients who have undergone ACL reconstruction. It is concluded that a test battery consisting of a knee-extension, knee-flexion and leg-press muscle power test had high ability to determine deficits in leg power 6 months after ACL injury and reconstruction. Only a minority of the patients had restored leg muscle power. The clinical relevance is that the test battery may contribute to the decision-making process when deciding whether and when patients can safely return to strenuous physical activities after an ACL injury or reconstruction. PMID:16477472

  16. Evaluation of Subchondral Bone Marrow Lipids of Acute Anterior Cruciate Ligament (ACL)-Injured Patients at 3 T

    PubMed Central

    Wang, Ligong; Salibi, Nouha; Chang, Gregory; Bencardino, Jenny T.; Babb, James S.; Rokito, Andrew; Jazrawi, Laith; Sherman, Orrin; Regatte, Ravinder R.

    2014-01-01

    Rationale and Objectives The objectives of this study were to investigate the changes in compartment-specific subchondral bone marrow lipids of femoral–tibial bone in acute anterior cruciate ligament (ACL)-injured patients compared to that of healthy volunteers and patients with osteoarthritis (OA) (Kellgren–Lawrence [KL] grade 2–3). Materials and Methods A total of 55 subjects were recruited in the study and subdivided into three subgroups: 17 healthy controls (4 females, 13 males; mean age = 41 ± 16, age range 24–78 years), 17 patients with acute ACL injury (3 females, 14 males; mean age = 30 ± 11, age range 18–61 years), and 21 patients with KL2–3 OA (12 females, 9 males; mean age = 65 ± 12, age range 44–89 years). Routine clinical proton density–weighted fast spin echo images in sagittal (without fat saturation), axial, and coronal (fat saturation) planes were acquired on a 3 T clinical scanner for cartilage morphology using Whole-Organ Magnetic Resonance Imaging Score grading. A voxel of 10 × 10 × 10 mm3 was positioned in the medial and lateral compartments of the tibia and femur for proton magnetic resonance spectroscopy measurements using the single voxel stimulated echo acquisition mode pulse sequence. All proton magnetic resonance data were processed with Java-based magnetic resonance user interface. Wilcoxon rank sum test and mixed model two-way analysis of variance were performed to determine significant differences between different compartments and examine the effect of ACL injury, OA grade and compartment, and their interactions. Results The index of unsaturation in lateral tibial compartment in ACL-injured patients was significantly higher (P < .05) than all compartments except lateral femoral in patients with KL2–3 OA. Significantly lower values (P < .05) were also identified in saturated lipids at 2.03 ppm in all compartments in ACL-injured patients than those of all compartments in patients with KL2–3 OA. Conclusions The preliminary results suggest that the indices of unsaturation in the lateral tibial compartment and the peaks of saturated lipids at 1.3 and 2.03 ppm in medial tibial compartment may be clinically useful to characterize subchondral bone marrow among healthy controls, acute ACL-injured patients, and patients with OA. PMID:24717549

  17. Sex Influences the Biomechanical Outcomes of Anterior Cruciate Ligament Reconstruction in a Pre-Clinical Large Animal Model

    PubMed Central

    Kiapour, Ata M.; Fleming, Braden C.; Proffen, Benedikt L.; Murray, Martha M.

    2015-01-01

    Background The risk of anterior cruciate ligament (ACL) injury is 2-10 times greater in women than men. While the role of sex on injury risk is well established, its effects on surgical outcomes remain controversial. Purpose To investigate whether the biomechanical outcomes of ACL reconstruction are affected by sex using an established porcine model that displays similar sex-specific differences in knee anatomy and ligament structural properties to humans. We hypothesized there are sex differences in ACL reconstruction outcomes with regards to the graft structural properties, knee laxity and cartilage damage. Study Design Controlled Laboratory Study. Methods A total of 41 (23 M, 18 F) adolescent Yucatan minipigs underwent unilateral ACL transection and ACL reconstruction using sex-matched bone-patellar tendon-bone allografts (with or without additional bio-enhancement). Graft biomechanical and histological properties, knee laxity and cartilage damage were assessed after 15 weeks. A two-factor ANOVA was used to investigate the effect of sex on all the measured outcomes after adjusting for the treatment effect. Results After 15 weeks of healing, female pigs had a significantly lower mean normalized graft yield load (by 18.5±7.7%; p=0.023) and linear stiffness (by 11.9±5.6%; p=0.043), compared to males. Female pigs had a significantly greater side-to-side differences in AP knee laxity at 30° (by 1.4±0.6 mm; p=0.028) and 90° (by 1.8±0.8 mm; p=0.032). Female pigs had a lower graft vascular density (by 0.8±0.3 [analog scoring];p=0.021) with similar cellular and collagen-based histologic scores in both sexes (p>0.6). Female pigs also had a significantly larger area of cartilage damage (by 43.3±14.8 mm2; p=0.014) after conventional ACL reconstruction than their male counterparts. Conclusion Female pigs had significantly worse outcomes (i.e., graft structural properties, knee laxity and cartilage damage) compared to males in this translational model after 15 weeks of healing. Clinical Relevance These data suggest that further optimization of ACL injury treatments may be needed to accommodate each sex instead of using a “one fits all” approach to improve surgical outcomes, decrease incidence of re-injury, and decrease posttraumatic osteoarthritis risk following ACL reconstruction. PMID:25939612

  18. Results of rasping of meniscal tears with and without anterior cruciate ligament injury as evaluated by second-look arthroscopy

    Microsoft Academic Search

    Yuji Uchio; Mitsuo Ochi; Nobuo Adachi; Kenzo Kawasaki; Junji Iwasa

    2003-01-01

    Purpose: Meniscal rasping without suturing has been experimentally shown to stimulate vascular induction in tears in the avascular zone of menisci, resulting in meniscal healing. The goals of this study were to arthroscopically assess the results of meniscal rasping and analyze the factors affecting meniscal healing. Type of Study: Retrospective cohort study. Methods: Forty-eight torn menisci in 47 patients (age

  19. Arthroscopic and endoscopicallograft reconstruction

    Microsoft Academic Search

    E. Marlowe Goble

    1995-01-01

    Advantages for the choice of an allograft anterior cruciate ligament (ACL) reconstruction include the following:rapid and uncomplicated rehabilitation; avoidance of the need to harvest a graft from the affected individual, thus avoiding possible complications; prolonged rehabilitation; a readily available source of graft material in the case of revision ACL surgery; adequate tissue availability when the need exists for multiple ligament

  20. Interference Screw Fixation of Soft Tissue Grafts in Anterior Cruciate Ligament Reconstruction: Part 1Effect of Tunnel Compaction by Serial Dilators Versus Extraction Drilling on the Initial Fixation Strength

    Microsoft Academic Search

    Janne T. Nurmi; Pekka Kannus; Harri Sievänen; Timo Järvelä; Markku Järvinen; Teppo L. N. Järvinen

    2004-01-01

    Background:Compaction of the bone-tunnel walls by serial dilation is believed to enhance the interference screw fixation strength of the soft tissue grafts in anterior cruciate ligament (ACL) reconstruction.Hypothesis:Serial dilation enhances the fixation strength of soft tissue grafts in ACL reconstruction over extraction drilling.Study Design:Randomized experimental study.Methods:Initial fixation strength of the doubled anterior tibialis tendon grafts (fixed with a bioabsorbable interference

  1. Evaluation of the vascular status of autogenous hamstring tendon grafts after anterior cruciate ligament reconstruction in humans using magnetic resonance angiography.

    PubMed

    Arai, Yuji; Hara, Kunio; Takahashi, Takeshi; Urade, Hidenori; Minami, Ginjiro; Takamiya, Hisatake; Kubo, Toshikazu

    2008-04-01

    The purpose of this study is to evaluate the vascular status of autogenous semitendinosus grafts after anterior cruciate ligament reconstruction in humans using magnetic resonance angiography. Twelve patients (mean age, 24.3 years) who underwent anterior cruciate ligament reconstruction with the 4-strand semitendinosus tendon were studied. All patients underwent contrast-enhanced magnetic resonance angiography and second-look arthroscopy in their reconstructed knees on an average of 15.8 months (range 9-22 months) after surgery. Blood vessels to the graft were visualised and contrast medium enhancement for visualising the femoral tunnel, graft, and tibial tunnel was evaluated. Magnetic resonance angiography showed that a branch of the middle genicular artery extended to the upper side of the graft through the posterior capsule and that branches of the inferior genicular artery ended at the lower side of the graft in all patients. These were consistent with the actual findings of the second-look arthroscopy. We found contrast medium enhancement in the femoral and tibial tunnels in all patients. The effect of enhancement at 9 months after ACL reconstruction was higher than that at 22 months. The graft showed enhancement patterns in the posterior portion of the femoral side and the anterior portion of the tibial side. This study demonstrated that the branches of the middle and inferior genicular arteries provide blood supply to the graft, which may influence the maturation of the graft. The revascularisation of the bone tunnels could play an important role in the healing of the ligament-bone tunnel junction. PMID:18193195

  2. Patellar Tendon Graft Reconstruction for Midsubstance Anterior Cruciate Ligament Rupture in Junior High School AthletesAn Algorithm for Management

    Microsoft Academic Search

    John R. McCarroll; K. Donald Shelbourne; David A. Porter; Arthur C. Rettig; Scott Murray

    1994-01-01

    Between 1976 and 1988 we treated 75 junior high athletes who had midsubstance ruptures of the ante rior cruciate ligament and open physes. Thirty-eight children were initially treated conservatively and later had an intraarticular patellar tendon graft reconstruc tion, 2 patients underwent extraarticular reconstruc tion and then later had a patellar tendon graft intraar ticular reconstruction, and 20 children had

  3. Arthroscopic surgery of the knee on the U.S. Naval Hospital Ships during Operation Desert Shield.

    PubMed

    Buckley, S L; Jones, A A; Bosse, M J; Holmes, C A; Culp, R W; Smallman, T; McLaughlin, C M

    1992-09-01

    Between September 1990 and January 1991, while deployed to the Persian Gulf for Operation Desert Shield, 118 patients underwent arthroscopic surgery of the knee on the U.S. Naval Hospital Ships USNS Mercy and USNS Comfort. There were 113 men and 5 women, with an average age of 28 years (range, 19-59 years). The most common findings at the time of arthroscopy were meniscus tears (53%), anterior cruciate ligament tears (29%), and normal arthroscopic examinations (9%). There were three complications, two hemarthroses and one superficial portal site infection. Seventy patients (59%) were able to be returned to duty at an average of 6 days post-operatively, obviating the need to evacuate these patients out of the Middle East theater to Europe or the United States, thus avoiding additional delay, expense, and loss of the service member to his military unit. PMID:1454189

  4. Protection of the medial femoral condyle articular cartilage during drilling of the femoral tunnel through the accessory medial portal in anatomic anterior cruciate ligament reconstruction.

    PubMed

    Abdelkafy, Ashraf

    2012-12-01

    Accurate positioning of the femoral tunnel in the native femoral anterior cruciate ligament (ACL) footprint requires drilling through an accessory medial portal (AMP). The AMP is located far medial and at a low level. Despite the benefits of drilling through the AMP, it is possible that the drill bit head will injure the articular cartilage of the medial femoral condyle as it slides along the guide pin to the femoral insertion of the ACL. Because more surgeons are now performing anatomic ACL reconstructions and shifting from transtibial drilling toward transportal drilling, the risk of this injury might be increasing, especially during the beginning of their learning curve. To avoid such injury, a bio-interference screw sheath is used. It is inserted through the AMP over the guide pin until it reaches near the medial wall of the lateral femoral condyle. The drill bit is inserted over the guide pin and through the bio-interference screw sheath. Using the bio-interference screw sheath not only protects the articular cartilage of the medial femoral condyle but also protects the medial meniscus, posterior cruciate ligament, and skin of the AMP from injury because of the close proximity of the drill bit head to these structures during transportal drilling. PMID:23766987

  5. Direct Visualization of Existing Footprint and Outside-In Drilling of the Femoral Tunnel in Anterior Cruciate Ligament Reconstruction in the Knee.

    PubMed

    Sutter, E Grant; Anderson, John A; Garrett, William E

    2015-04-01

    Improper femoral tunnel placement in anterior cruciate ligament (ACL) reconstruction is a significant problem and may be a cause of ACL graft failure and abnormal kinematics, which may lead to late degenerative changes after reconstruction. Recently, there has been concern that the transtibial approach may contribute to nonanatomic placement of the femoral tunnel, resulting in abnormal knee kinematics. Tibial-independent techniques can provide more anatomic placement of the ACL graft, but these can be technically demanding. This technical note describes the senior author's technique to directly identify the femoral ACL remnant and use the center of the femoral ACL footprint and retrograde drilling to create an anatomic femoral socket for single-bundle reconstruction. This technique provides femoral tunnel placement based on identification of a patient-specific ACL footprint instead of averaged anatomic measurements from large groups. This technique has been shown to produce anatomic ACL graft position and orientation and restore more normal knee kinematics. PMID:26052485

  6. Direct Visualization of Existing Footprint and Outside-In Drilling of the Femoral Tunnel in Anterior Cruciate Ligament Reconstruction in the Knee

    PubMed Central

    Sutter, E. Grant; Anderson, John A.; Garrett, William E.

    2015-01-01

    Improper femoral tunnel placement in anterior cruciate ligament (ACL) reconstruction is a significant problem and may be a cause of ACL graft failure and abnormal kinematics, which may lead to late degenerative changes after reconstruction. Recently, there has been concern that the transtibial approach may contribute to nonanatomic placement of the femoral tunnel, resulting in abnormal knee kinematics. Tibial-independent techniques can provide more anatomic placement of the ACL graft, but these can be technically demanding. This technical note describes the senior author's technique to directly identify the femoral ACL remnant and use the center of the femoral ACL footprint and retrograde drilling to create an anatomic femoral socket for single-bundle reconstruction. This technique provides femoral tunnel placement based on identification of a patient-specific ACL footprint instead of averaged anatomic measurements from large groups. This technique has been shown to produce anatomic ACL graft position and orientation and restore more normal knee kinematics.

  7. [Postero-internal menisco-capsular disinsertions associated with chronic instabilities of the knee caused by rupture of the anterior cruciate ligament].

    PubMed

    Lemaire, M; Combelles, F; Miremad, C; Van Vooren, P

    1984-01-01

    Posterior menisco-capsular tears of the medial compartment of the knee can be considered as a complication of rupture of the anterior cruciate ligament and the consequent medial instability. The lesion is more a capsular lesion than a true meniscal one and it is related to an excessive stress on the oblique fibres of the ligament of Hughston attached to the meniscus. The diagnosis is based on arthrography made with meticulous technique. The lesion must be differentiated from true meniscal tears because it can be sutured. One hundred and twenty five such lesions have been operated on and reviewed after a follow-up of an average of two years. The technique must be very precise to prevent any secondary lesion due to surgery and to avoid any plaster cast immobilisation. The results have been satisfactory in 69 p. 100. They should be improved with more accurate surgical technique and with more precise indications. PMID:6241335

  8. [Control of muscle reinforcement with the isokinetic endurance test in patients undergoing reconstruction of the anterior cruciate ligament of the knee].

    PubMed

    Felicetti, G; Brignoli, E; Rovescala, R; Maini, M; Scarabelli, D A

    1996-01-01

    In the present study authors analyzed a group of fifty patients (mean age 24.3 years) affected by a chronic lesion of the anterior cruciate ligament of the knee, who underwent a ACL reconstruction by free patellar tendon in arthroscopy. Each of these patients carried out a standardized rehabilitative training and underwent an isokinetic evaluation immediately before and at 3, 4 and 6 months after ACL reconstruction. The considered parameters were the increasing of both strength and work in the standardized times at the angular speed of 60 and 180 degrees/sec. Our results, compared to the pre surgery, showed a high decrease of both strength and work at the third month after surgery, especially regarding the extensor muscles (-44% and -38% respectively); we observed an increase between the third and the fourth month, even if the parameters of the extensors still remain much lower than the controlateral healthy side. PMID:9312448

  9. The Low Anterior Five-O'clock Portal During Arthroscopic Shoulder Surgery Performed in the Beach-Chair Position

    Microsoft Academic Search

    Albert W. Pearsall; Tom F. Holovacs; Kevin P. Speer

    1999-01-01

    We evaluated the difficulty, accuracy, and safety of establishing a low anterior 5-o'clock portal for anterior capsulolabral repair in patients positioned in the beach-chair position during shoulder arthroscopy. An initial 5-o'clock portal was created using an inside-out technique as described by Davidson and Tibone. During establishment of the portal, significant force was required to lever the humeral head laterally, and

  10. Single- vs. double-bundle anterior cruciate ligament reconstruction: a new aspect of knee assessment during activities involving dynamic knee rotation.

    PubMed

    Czamara, Andrzej; Królikowska, Aleksandra; Szuba, ?ukasz; Widuchowski, Wojciech; Kentel, Maciej

    2015-02-01

    Few studies have compared single-bundle (SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) in the knee joint during activities involving change-of-direction maneuvers and knee rotation. This study examined whether the type of ACLR contributes to postphysiotherapy outcomes, with an emphasis on knee function assessment during activities involving dynamic knee rotation. Fifteen male patients after SB ACLR and 15 male patients after DB ACLR took part in the same physiotherapy program. Twenty-four weeks after ACLR, both groups underwent anterior laxity measurement, pivot shift tests, range of movement and joint circumference measurements, subjective assessment of pain and stability levels in the knee joint, peak torque measurement of the muscles rotating the tibia toward the femur, and a run test with maximal speed and change-of-direction maneuvers. Comparative analysis did not show any differences between the results of anterior tibial translation, pivot shift test, range of movement and joint circumference, and subjective assessment of pain and knee joint stability levels. No differences were noted between the groups in peak torque values obtained from the muscles responsible for internal and external tibial rotation or results of the run test. The data obtained from this study can be used by research teams to monitor and compare the effectiveness of various study protocols involving surgical and physiotherapy treatment. The data are especially useful when combined with the clinical assessment of patients who would like to return to sport. PMID:25148470

  11. Arthroscopic Surgery.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    Arthroscopic surgery (or microsurgery) is a significant breakthrough in treating knee injuries. Its applications range from basic diagnosis to arthroscopic menisectomy, although its use in some procedures is still highly controversial. Many surgeons perform the diagnostic procedure, but follow this with the conventional surgical approach.…

  12. A pilot study on the relationship between physical impairment and activity restriction in persons with anterior cruciate ligament reconstruction at long-term follow-up.

    PubMed

    Pantano, K J; Irrgang, J J; Burdett, R; Delitto, A; Harner, C; Fu, F H

    2001-11-01

    This study examined the relationship between impairment of the knee and activity restriction during activities of daily living and sports following anterior cruciate ligament reconstruction. Knee range of motion, swelling, pain, instability, ligamentous laxity, isometric and isokinetic muscle function and performance-based measures of activity restriction were measured in 44 subjects. Four measures of patient-reported activity restrictions, including the Activities of Daily Living, Sports Activities Scales of the Knee Outcome Survey, and global ratings of function during activities of daily life and sports, were statistically combined to create a composite variable representing the level of patient-reported activity restrictions for each subject. Hierarchical regression analysis revealed that 17% of the variability in patient-reported activity restrictions was accounted for by age, length of postoperative follow-up, and mechanism of injury. Addition of the one-legged hop, Lachman, anterior drawer, and varus stress tests accounted for an additional 40% of the variability of function. When pain and giving way were added to the model, 79% of the variability was explained. PMID:11734876

  13. Prospective Randomized Clinical Evaluation of Conventional Single-Bundle, Anatomic Single-Bundle, and Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: 281 Cases With 3- to 5Year Follow-up

    Microsoft Academic Search

    Mohsen Hussein; Carola F. van Eck; Andrej Cretnik; Dejan Dinevski; Freddie H. Fu

    2012-01-01

    Background: Three different techniques of anterior cruciate ligament (ACL) reconstruction—conventional (transtibial) single bundle (CSB), anatomic single bundle (ASB), and anatomic double bundle (ADB)—have been described.Purpose: To determine if double-bundle reconstruction is needed to restore rotational stability or if anatomic placement of a single bundle can yield similar results.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: From December 2005 to

  14. A simple method for identifying the acromioclavicular joint during arthroscopic procedures.

    PubMed

    Javed, Saqib; Heasley, Richard; Ravenscroft, Matt

    2014-06-01

    Arthroscopic acromioclavicular joint excision is performed via an anterior portal and is technically demanding. We present a simple method for identifying the acromioclavicular joint during arthroscopic procedures. PMID:24876686

  15. Dosage Effects of Neuromuscular Training Intervention to Reduce Anterior Cruciate Ligament Injuries in Female Athletes: Meta-and Sub-group Analyses

    PubMed Central

    Sugimoto, Dai; Myer, Gregory D.; Barber Foss, Kim D.; Hewett, Timothy E.

    2014-01-01

    Background Although a series of meta-analysis demonstrated neuromuscular training (NMT) is an effective intervention to reduce anterior cruciate ligament (ACL) injury in female athletes, the potential existence of a dosage effect remains unknown. Objective To systematically review previously published clinical trials and evaluate potential dosage effects of NMT for ACL injury reduction in female athletes. Design Meta- and Sub-group analyses Setting The key words “knee”, “anterior cruciate ligament”, “ACL”, “prospective”, “neuromuscular”, “training”, “female”, and “prevention” were utilized in PubMed and EBSCO host for studies published between 1995 and May 2012. Participants Inclusion criteria set for studies in the current analysis were: 1) recruited female athletes as subjects, 2) documented the number of ACL injuries, 3) employed a NMT intervention aimed to reduce ACL injuries, 4) had a control group, 5) used a prospective control trial design and 6) provided NMT session duration and frequency information. Main outcome measures The number of ACL injuries and female athletes in each group (control and intervention) were compared based on duration, frequency, and volume of NMT through odds ratio (OR). Results A total of 14 studies were reviewed. Analyses that compared the number of ACL injuries with short versus long NMT duration showed greater ACL injury reduction in female athletes who were in the long NMT duration (OR:0.35, 95%CI: 0.23, 0.53, p=0.001) than the short NMT duration (OR: 0.61, 95%CI: 0.41, 0.90, p=0.013) group. Analysis that compared single versus multi NMT frequency indicated greater ACL injury reduction in multi NMT frequency (OR: 0.35, 95%CI: 0.23, 0.53, p=0.001) compared to single NMT frequency (OR: 0.62, 95%CI:0.41, 0.94, p=0.024). Combining the duration and frequency of NMT programs, an inverse dose-response association emerged among low (OR: 0.66, 95%CI: 0.43, 0.99, p=0.045), moderate (OR: 0.46, 95%CI: 0.21, 1.03, p=0.059), and high (OR:0.32, 95%CI: 0.19, 0.52, p=0.001) NMT volume categories. Conclusions The inverse dose-response association observed in the subgroup analysis suggests that the higher NMT volume, the greater prophylactic effectiveness of the NMT program and increased benefit in ACL injury reduction among female athletes. PMID:24370992

  16. Evaluating the distance between the femoral tunnel centers in anatomic double-bundle anterior cruciate ligament reconstruction using a computer simulation

    PubMed Central

    Tashiro, Yasutaka; Okazaki, Ken; Iwamoto, Yukihide

    2015-01-01

    Purpose We aimed to clarify the distance between the anteromedial (AM) bundle and posterolateral (PL) bundle tunnel-aperture centers by simulating the anatomical femoral tunnel placement during double-bundle anterior cruciate ligament reconstruction using 3-D computer-aided design models of the knee, in order to discuss the risk of tunnel overlap. Relationships between the AM to PL center distance, body height, and sex difference were also analyzed. Patients and methods The positions of the AM and PL tunnel centers were defined based on previous studies using the quadrant method, and were superimposed anatomically onto the 3-D computer-aided design knee models from 68 intact femurs. The distance between the tunnel centers was measured using the 3-D DICOM software package. The correlation between the AM–PL distance and the subject’s body height was assessed, and a cutoff height value for a higher risk of overlap of the AM and PL tunnel apertures was identified. Results The distance between the AM and PL centers was 10.2±0.6 mm in males and 9.4±0.5 mm in females (P<0.01). The AM–PL center distance demonstrated good correlation with body height in both males (r=0.66, P<0.01) and females (r=0.63, P<0.01). When 9 mm was defined as the critical distance between the tunnel centers to preserve a 2 mm bony bridge between the two tunnels, the cutoff value was calculated to be a height of 160 cm in males and 155 cm in females. Conclusion When AM and PL tunnels were placed anatomically in simulated double-bundle anterior cruciate ligament reconstruction, the distance between the two tunnel centers showed a strong positive correlation with body height. In cases with relatively short stature, the AM and PL tunnel apertures are considered to be at a higher risk of overlap when surgeons choose the double-bundle technique. PMID:26170727

  17. Allogeneic versus autologous derived cell sources for use in engineered bone-ligament-bone grafts in sheep anterior cruciate ligament repair.

    PubMed

    Mahalingam, Vasudevan D; Behbahani-Nejad, Nilofar; Horine, Storm V; Olsen, Tyler J; Smietana, Michael J; Wojtys, Edward M; Wellik, Deneen M; Arruda, Ellen M; Larkin, Lisa M

    2015-03-01

    The use of autografts versus allografts for anterior cruciate ligament (ACL) reconstruction is controversial. The current popular options for ACL reconstruction are patellar tendon or hamstring autografts, yet advances in allograft technologies have made allogeneic grafts a favorable option for repair tissue. Despite this, the mismatched biomechanical properties and risk of osteoarthritis resulting from the current graft technologies have prompted the investigation of new tissue sources for ACL reconstruction. Previous work by our lab has demonstrated that tissue-engineered bone-ligament-bone (BLB) constructs generated from an allogeneic cell source develop structural and functional properties similar to those of native ACL and vascular and neural structures that exceed those of autologous patellar tendon grafts. In this study, we investigated the effectiveness of our tissue-engineered ligament constructs fabricated from autologous versus allogeneic cell sources. Our preliminary results demonstrate that 6 months postimplantation, our tissue-engineered auto- and allogeneic BLB grafts show similar histological and mechanical outcomes indicating that the autologous grafts are a viable option for ACL reconstruction. These data indicate that our tissue-engineered autologous ligament graft could be used in clinical situations where immune rejection and disease transmission may preclude allograft use. PMID:25397361

  18. Outcome of combined unicompartmental knee replacement and combined or sequential anterior cruciate ligament reconstruction: a study of 52 cases with mean follow-up of five years.

    PubMed

    Weston-Simons, J S; Pandit, H; Jenkins, C; Jackson, W F M; Price, A J; Gill, H S; Dodd, C A F; Murray, D W

    2012-09-01

    The Oxford unicompartmental knee replacement (UKR) is an established treatment option in the management of symptomatic end-stage medial compartmental osteoarthritis (MCOA), which works well in the young and active patient. However, previous studies have shown that it is reliable only in the presence of a functionally intact anterior cruciate ligament (ACL). This review reports the outcomes, at a mean of five years and a maximum of ten years, of 52 consecutive patients with a mean age of 51 years (36 to 57) who underwent staged or simultaneous ACL reconstruction and Oxford UKR. At the last follow-up (with one patient lost to follow-up), the mean Oxford knee score was 41 (sd 6.3; 17 to 48). Two patients required conversion to TKR: one for progression of lateral compartment osteoarthritis and one for infection. Implant survival at five years was 93% (95% CI 83 to 100). All but one patient reported being satisfied with the procedure. The outcome was not significantly influenced by age, gender, femoral or tibial tunnel placement, or whether the procedure was undertaken at one- or two-stages. In summary, ACL reconstruction and Oxford UKR gives good results in patients with end-stage MCOA secondary to ACL deficiency. PMID:22933493

  19. Isokinetic dynamometer evaluation of the effects of early thigh diameter difference on thigh muscle strength in patients undergoing anterior cruciate ligament reconstruction with hamstring tendon graft

    PubMed Central

    K?l?nç, Bekir Eray; Kara, Adnan; Camur, Savas; Oc, Yunus; Celik, Haluk

    2015-01-01

    After anterior cruciate ligament (ACL) reconstruction, which muscle groups are more affected from frequently developing thigh muscle atrophy is a matter of debate. We evaluate the effect of thigh circumference difference between patients’ knees who were administered the ACL reconstruction with hamstring tendon autograft and intact knees, on torque between the hamstring and quadriceps muscles. Fifty-five patients at least 6 months follow-up period available were included in our study. Power measurements of quadriceps and hamstring muscle groups in patients’ extremities were done by using isokinetic dynamometer. The maximum torque values at 60°/sec, 240°/sec in frequency, positions of flexion and extension were determined. In accordance with our findings it is still possible to encounter the thigh atrophy in average 28 months after ACL reconstruction surgery even under physical rehabilitation programs and appropriate follow-up. It is inevitable for the clinician to consider these changes in diagnosis and rehabilitation stages. It can’t be ignored that muscle weakness mechanisms developing in the thigh circumference vary according to the thigh muscle group and knee flexors play an important role in thigh atrophy when determining an appropriate rehabilitation program after reconstruction application. PMID:25960982

  20. Graft-bending angle and femoral tunnel length after single-bundle anterior cruciate ligament reconstruction: comparison of the transtibial, anteromedial portal and outside-in techniques.

    PubMed

    Shin, Y S; Ro, K H; Jeon, J H; Lee, D H

    2014-06-01

    We used immediate post-operative in vivo three-dimensional computed tomography to compare graft bending angles and femoral tunnel lengths in 155 patients who had undergone single-bundle reconstruction of the anterior cruciate ligament using the transtibial (n = 37), anteromedial portal (n = 72) and outside-in (n = 46) techniques. The bending angles in the sagittal and axial planes were significantly greater but the coronal-bending angle was significantly less in the transtibial group than in the anteromedial portal and outside-in groups (p < 0.001 each). The mean length of the femoral tunnel in all three planes was significantly greater in the transtibial group than the anteromedial portal and outside-in groups (p < 0.001 each), but all mean tunnel lengths in the three groups exceeded 30 mm. The only significant difference was the coronal graft- bending angle in the anteromedial portal and outside-in groups (23.5° vs 29.8°, p = 0.012). Compared with the transtibial technique, the anteromedial portal and outside-in techniques may reduce the graft-bending stress at the opening of the femoral tunnel. Despite the femoral tunnel length being shorter in the anteromedial portal and outside-in techniques than in the transtibial technique, a femoral tunnel length of more than 30 mm in the anteromedial portal and outside-in techniques may be sufficient for the graft to heal. PMID:24891573

  1. Localized pigmented villonodular synovitis of the anterior cruciate ligament of the knee: an exceptional presentation of a rare disease with neoplastic and inflammatory features.

    PubMed

    Galli, M; Ciriello, V; Menghi, A; Perisano, C; Maccauro, G; Marzetti, E

    2012-01-01

    Pigmented villonodular synovitis (PVNS) is a rare condition, most commonly involving the knee joint. PVNS is locally aggressive and can invade and destroy surrounding soft tissue and bone, leading to anatomical and functional deterioration of the affected joint. Localized PVNS is an unusual presentation of the disease, generally consisting of a nodular lesion protruding into the articular cavity. Localized PVNS of the knee can mimic other joint disorders which may pose a challenge for a correct diagnosis. Given the locally aggressive behavior of PVNS, prompt identification and excision of the lesion are instrumental to avoid complications. Here, we report a rare case of localized cystic PVNS involving the anterior cruciate ligament of the knee in a 32-year-old woman with persistent knee pain, in whom magnetic resonance imaging was inconclusive. The diagnosis was achieved via arthroscopy and histology. We also present a concise review of the literature on this pathological entity as well as a discussion on the differential diagnosis between localized PVNS and other intra-articular cystic lesions. PMID:23298503

  2. Segmentation of anterior cruciate ligament in knee MR images using graph cuts with patient-specific shape constraints and label refinement.

    PubMed

    Lee, Hansang; Hong, Helen; Kim, Junmo

    2014-12-01

    We propose a graph-cut-based segmentation method for the anterior cruciate ligament (ACL) in knee MRI with a novel shape prior and label refinement. As the initial seeds for graph cuts, candidates for the ACL and the background are extracted from knee MRI roughly by means of adaptive thresholding with Gaussian mixture model fitting. The extracted ACL candidate is segmented iteratively by graph cuts with patient-specific shape constraints. Two shape constraints termed fence and neighbor costs are suggested such that the graph cuts prevent any leakage into adjacent regions with similar intensity. The segmented ACL label is refined by means of superpixel classification. Superpixel classification makes the segmented label propagate into missing inhomogeneous regions inside the ACL. In the experiments, the proposed method segmented the ACL with Dice similarity coefficient of 66.47±7.97%, average surface distance of 2.247±0.869, and root mean squared error of 3.538±1.633, which increased the accuracy by 14.8%, 40.3%, and 37.6% from the Boykov model, respectively. PMID:25305694

  3. In vitro and in vivo evaluation of heparin mediated growth factor release from tissue-engineered constructs for anterior cruciate ligament reconstruction.

    PubMed

    Leong, Natalie L; Arshi, Armin; Kabir, Nima; Nazemi, Azadeh; Petrigliano, Frank A; Wu, Ben M; McAllister, David R

    2015-02-01

    Anterior cruciate ligament (ACL) rupture is a common injury often necessitating surgical treatment with graft reconstruction. Due to limitations associated with current graft options, there is interest in a tissue-engineered substitute for use in ACL regeneration. While they represent an important step in translation to clinical practice, relatively few in vivo studies have been performed to evaluate tissue-engineered ACL grafts. In the present study, we immobilized heparin onto electrospun polycaprolactone scaffolds as a means of incorporating basic fibroblast growth factor (bFGF) onto the scaffold. In vitro, we demonstrated that human foreskin fibroblasts (HFFs) cultured on bFGF-coated scaffolds had significantly greater cell proliferation. In vivo, we implanted electrospun polycaprolactone grafts with and without bFGF into athymic rat knees. We analyzed the regenerated ACL using histological methods up to 16 weeks post-implantation. Hematoxylin and eosin staining demonstrated infiltration of the grafts with cells, and picrosirius red staining demonstrated aligned collagen fibers. At 16 weeks postop, mechanical testing of the grafts demonstrated that the grafts had approximately 30% the maximum load to failure of the native ACL. However, there were no significant differences observed between the graft groups with or without heparin-immobilized bFGF. While this study demonstrates the potential of a regenerative medicine approach to treatment of ACL rupture, it also demonstrates that in vitro results do not always predict what will occur in vivo. PMID:25363620

  4. A decreased volume of the medial tibial spine is associated with an increased risk of suffering an anterior cruciate ligament injury for males but not females.

    PubMed

    Sturnick, Daniel R; Argentieri, Erin C; Vacek, Pamela M; DeSarno, Michael J; Gardner-Morse, Mack G; Tourville, Timothy W; Slauterbeck, James R; Johnson, Robert J; Shultz, Sandra J; Beynnon, Bruce D

    2014-11-01

    Measurements of tibial plateau subchondral bone and articular cartilage slope have been associated with the risk of suffering anterior cruciate ligament (ACL) injury. Such single-plane measures of the tibial plateau may not sufficiently characterize its complex, three-dimensional geometry and how it relates to knee injury. Further, the tibial spines have not been studied in association with the risk of suffering a non-contact ACL injury. We questioned whether the geometries of the tibial spines are associated with non-contact ACL injury risk, and if this relationship is different for males and females. Bilateral MRI scans were acquired on 88 ACL-injured subjects and 88 control subjects matched for sex, age and sports team. Medial and lateral tibial spine geometries were characterized with measurements of length, width, height, volume and anteroposterior location. Analyses of females revealed no associations between tibial spine geometry and risk of ACL injury. Analyses of males revealed that an increased medial tibial spine volume was associated with a decreased risk of ACL injury (OR?=?0.667 per 100?mm(3) increase). Smaller medial spines could provide less resistance to internal rotation and medial translation of the tibia relative to the femur, subsequently increasing ACL strains and risk of ACL injury. PMID:24962098

  5. Patellar tendon and hamstring moment-arms and cross-sectional area in patients with anterior cruciate ligament reconstruction and controls.

    PubMed

    Kellis, Eleftherios; Karagiannidis, Evaggelos; Patsika, Glykeria

    2015-08-01

    The purpose of this study was to examine the moment-arm and cross-sectional area (CSA) of the patellar tendon (PT) and the hamstrings after anterior cruciate ligament (ACL) reconstruction. The right knee of five males who underwent ACL reconstruction with a PT graft and five age-matched controls was scanned using magnetic resonance image scans. Based on three-dimensional (3D) solids of the PT, CSAs and moment-arms of semitendinous (ST), biceps femoris (BF) long head and semimembranosus (SM) were estimated. Analysis of variance indicated no significant group differences in muscle moment-arms (p>0.05). 3D moment-arms of PT, ST and BF were significantly lower than the corresponding 2D values (p < 0.05). The ACL group displayed a significantly higher maximum BF CSA, a lower ST CSA (p < 0.05) but similar PT and SM CSAs compared with controls. It is concluded that any alterations in PT properties 1 year after harvesting do not affect knee muscle moment-arms compared with age-matched controls. Moment-arm estimation differed between 3D and 2D data, although it did not affect comparisons between ACL reconstruction group and controls. Design of rehabilitation programmes should take into consideration a potential alteration in hamstring morphology following surgery with a PT graft. PMID:24460238

  6. Single-Bundle Anterior Cruciate Ligament Reconstruction with Semitendinosus Tendon Using the PINN-ACL CrossPin System: Minimum 4-Year Follow-up

    PubMed Central

    Baek, Seung-Gil; Lee, Byoung-Joo; Lee, Chang-Hwa

    2015-01-01

    Purpose This study evaluated mid-term results of anterior cruciate ligament (ACL) reconstruction using the PINN-ACL CrossPin system that allowed for short graft fixation. Materials and Methods Forty-three patients underwent single-bundle ACL reconstruction with a 4-strand semitendinosus tendon graft using the PINN-ACL CrossPin system. Femoral fixation was done using the PINN-ACL CrossPin system, and the tibial side was fixed with post-tie and a bioabsorbable interference screw. The mean follow-up period was 50 months. Evaluation was done using the Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC) score and grade. Anterior displacement was assessed. Results There was improvement in the Lachman test and pivot-shift test at final follow-up, form grade II (n=40) or III (n=3) to grade I (n=3) or 0 (n=40) and from grade I (n=20) or II (n=10) to grade I (n=8) or 0 (n=22), respectively. The mean IKDC score was 88.7, and grade A and B were 93.0% at final follow-up. Side-to-side difference was improved from 6.7 mm to 2.1 mm at final follow-up. Complications occurred in 3 patients, a re-ruptured due to trauma at 2 years after surgery and a deep infection and a superficial infection. Conclusions The mid-term follow-up results of ACL reconstruction with the PINN-ACL CrossPin system were satisfactory. The PINN-ACL CrossPin can be considered as a useful instrument for short graft fixation. PMID:25750893

  7. Prevalence and location of bone bruises associated with anterior cruciate ligament injury and implications for mechanism of injury: A systematic review

    PubMed Central

    Patel, Sonika A.; Hageman, Jason; Quatman, Carmen E.; Wordeman, Samuel C.; Hewett, Timothy E.

    2013-01-01

    Background Bone bruising is commonly observed on magnetic resonance imaging (MRI) after non-contact anterior cruciate ligament (ACL) injury. Objectives The primary objective of this study was to determine if the location and prevalence of tibial and femoral bone bruises after ACL injury can be explained by specific injury mechanism(s). The secondary objective was to determine whether the bone bruise literature supports sex-specific injury mechanism(s). We hypothesized that most studies would report bone bruising in the lateral femoral condyle (LFC) and on the posterior lateral tibial plateau (LTP). Methods MEDLINE, PubMed, and SCOPUS were searched for studies that reported bone bruise prevalence and location in ACL-injured subjects. Sex differences in bone bruise patterns were assessed. Time from injury to imaging was assessed to account for confounding effects on bone bruise size and location. Results Thirty-eight studies met the inclusion/exclusion criteria. Anterior-posterior location of bone bruises within the tibiofemoral compartment was assessed in eleven studies. Only five of these studies reported bone bruise locations on both the tibia and the femur. The most common bone bruise combination in all five studies was on the LFC and the posterior LTP. Sex differences were only assessed in three studies, and only one reported significantly greater prevalence of LTP bruising in females. Conclusion Bone bruise patterns in the current literature support a valgus-driven ACL injury mechanism. However, more studies should report the specific locations of tibial and femoral bone bruises. There is insufficient evidence in the literature to determine whether there are sex-specific bone bruise patterns in ACL-injured subjects. PMID:24158783

  8. Quantitative Analysis of Human Cruciate Ligament Insertions

    Microsoft Academic Search

    Christopher D. Harner; Goo Hyun Baek; Tracy M. Vogrin; Gregory J. Carlin; Shinji Kashiwaguchi; Savio L. Y. Woo

    1999-01-01

    Summary: The objective of this study was to provide quantitative data on the insertion sites of the cruciate ligaments. In the first part of the study, we determined the shapes and sizes of the insertions of the anterior and posterior cruciate ligaments (ACL and PCL), and further compared these data with the midsubstance cross-sectional areas of the ligaments. The cross-sectional

  9. A security evaluation of the Rigid-fix crosses pin system used for anterior cruciate ligament reconstruction in tibial fixation site

    PubMed Central

    Fan, Huaqiang; Wang, Jian; Fu, Yangpan; Dong, Huixiang; Wang, Jianxiong; Tang, Cong; Huang, Changming; Shi, Zhanjun

    2014-01-01

    Our study aims to evaluate the safeness and feasibility that Rigid-fix cross pin system was used for hamstring graft anterior cruciate ligament (ACL) reconstruction in the tibial fixation site. In this study, eleven adult conservative cadaver knees were performed using the Rigid-fix Cross Pin device in the tibial fixation site for modeling the ACL reconstruction. The guide rod top was put through the tibial tunnel at the three horizontal positions: equal pace to articular facet (group A), the plane 5 mm below articular facet (group B), and the plane 10 mm below articular facet (group C). We gave four rotation positions to the cross-pin guide: 0°, 30°, 45°, 60° slope, referring to the parallel line of the posterior border of tibial plateau. We recorded the iatrogenic damages incidence, in the four different slope angle in the three groups, and then compare the incidence using Chi-Square test. Our results suggested that the incidence of chondral injury of tibial plateau in group B and group C was significantly lower compared to group A (? 2 A-B = 27.077, ? 2 A-C 45.517, P = 0.000); However, there was no significant difference for the incidence penetrating the medial condyle of tibial plateau among the three groups (? 2 = 5.733, P = 0.057); The highest incidence of injuring ligamentum transversum is in group A with 72.7%, especially at the 60° slope angle. In summary, our study suggested that in order to achieve the satisfactory clinical effect for the Rigid-fix system used in the tibia end fixation of ACL reconstruction surgery, the guide rod top should be put at the 5 mm below articular facet with a slope that parallel to the tibial medial plane at 30°-60° slope angle. PMID:25550991

  10. Simulated activity but real trauma: a systematic review on Nintendo Wii injuries based on a case report of an acute anterior cruciate ligament rupture.

    PubMed

    Müller, Sebastian A; Vavken, Patrick; Pagenstert, Geert

    2015-03-01

    Video gaming injuries are classically regarded as eccentric accidents and novelty diagnoses. A case of an anterior cruciate ligament (ACL) tear sustained during Wii boxing spurned us to review the literature for other Wii-related injuries and Wii-based posttraumatic rehabilitation. The English literature listed in PubMed was systematically reviewed by searching for "Wii (trauma or injury or fracture)." Full-text articles were included after duplicate, blinded review. The type and treatment of injury as well as the Wii-based rehabilitation programs found were analyzed. Additionally, a new case of an acute ACL tear-sustained playing, Wii boxing, is additionally presented. After exclusion of irrelevant articles, 13 articles describing Wii-related injuries were included reporting on 3 fractures, 6 nonosseous, 2 overuse injuries, and 2 rehabilitation programs using Wii for posttraumatic rehabilitation. Among the presented Wii-related injuries, only 12.5% were treated conservatively, whereas 87.5% underwent either surgical or interventional treatment. Because of the reported case, the literature search was limited to Wii-related injuries excluding other video games. Another limitation of this article lies in the fact that mainly case reports but no controlled trials exist on the topic. Assumingly, primarily the more severe injuries are reported in the literature with an unknown number of possibly minor injuries. Motion-controlled video games, such as Wii, are becoming increasingly popular as a recreational entertainment. Because of their wide acceptance and entertaining nature, they are also increasingly recognized as a tool in rehabilitation. However, although the activity is simulated, injuries are real. Our systematic review shows that Wii gaming can lead to severe injuries, sometimes with lasting limitations. PMID:25816033

  11. Elevated gastrocnemius forces compensate for decreased hamstrings forces during the weight-acceptance phase of single-leg jump landing: implications for anterior cruciate ligament injury risk.

    PubMed

    Morgan, Kristin D; Donnelly, Cyril J; Reinbolt, Jeffrey A

    2014-10-17

    Approximately 320,000 anterior cruciate ligament (ACL) injuries in the United States each year are non-contact injuries, with many occurring during a single-leg jump landing. To reduce ACL injury risk, one option is to improve muscle strength and/or the activation of muscles crossing the knee under elevated external loading. This study's purpose was to characterize the relative force production of the muscles supporting the knee during the weight-acceptance (WA) phase of single-leg jump landing and investigate the gastrocnemii forces compared to the hamstrings forces. Amateur male Western Australian Rules Football players completed a single-leg jump landing protocol and six participants were randomly chosen for further modeling and simulation. A three-dimensional, 14-segment, 37 degree-of-freedom, 92 muscle-tendon actuated model was created for each participant in OpenSim. Computed muscle control was used to generate 12 muscle-driven simulations, 2 trials per participant, of the WA phase of single-leg jump landing. A one-way ANOVA and Tukey post-hoc analysis showed both the quadriceps and gastrocnemii muscle force estimates were significantly greater than the hamstrings (p<0.001). Elevated gastrocnemii forces corresponded with increased joint compression and lower ACL forces. The elevated quadriceps and gastrocnemii forces during landing may represent a generalized muscle strategy to increase knee joint stiffness, protecting the knee and ACL from external knee loading and injury risk. These results contribute to our understanding of how muscle's function during single-leg jump landing and should serve as the foundation for novel muscle-targeted training intervention programs aimed to reduce ACL injuries in sport. PMID:25218505

  12. Comparing etoricoxib and celecoxib for preemptive analgesia for acute postoperative pain in patients undergoing arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial

    Microsoft Academic Search

    Tanarat Boonriong; Boonsin Tangtrakulwanich; Prapakorn Glabglay; Sasikaan Nimmaanrat

    2010-01-01

    BACKGROUND: The efficacy of selective cox-2 inhibitors in postoperative pain reduction were usually compared with conventional non-selective conventional NSAIDs or other types of medicine. Previous studies also used selective cox-2 inhibitors as single postoperative dose, in continued mode, or in combination with other modalities. The purpose of this study was to compare analgesic efficacy of single preoperative administration of etoricoxib

  13. Posterolateral sling reconstruction of the popliteus tendon: an all-arthroscopic technique.

    PubMed

    Feng, Hua; Hong, Lei; Geng, Xiang-su; Zhang, Hui; Wang, Xue-song; Zhang, Jin

    2009-07-01

    Injuries to the posterolateral corner of the knee present with variable injury patterns that have produced a number of reconstructive procedures in the literature. We present an all-arthroscopic technique that reconstructs the popliteus tendon using either a semitendinosus autograft or an anterior tibialis allograft. After exposure of the posterior tibia by use of the posteromedial and trans-septal portals for visualization and posterolateral portal as a working portal, the popliteus musculotendinous junction is identified. In preparation for tibial tunnel drilling, a Kirschner wire is passed from the Gerdy tubercle to the popliteus musculotendinous junction on the posterior tibia, which is localized by use of an anterior cruciate ligament tibial tunnel guide brought in through the posterolateral portal. The 6-mm tibial tunnel is then created. The femoral insertion site is identified by use of the anterolateral portals for visualization and by use of the accessory superolateral portal for debriding the synovial fold at the insertion of the popliteus tendon. A K-wire is inserted, and a socket is established. The selected graft is then implanted by passing the graft through the tibial tunnel from anterior to posterior with a passing suture and pulling it up anteriorly and superiorly to the femoral socket. The graft is tensioned with the knee in 90 degrees of flexion and in neutral rotation before fixation of both ends of the graft with bio-interference screws. PMID:19560646

  14. Volume and Contact Surface Area Analysis of Bony Tunnels in Single and Double Bundle Anterior Cruciate Ligament Reconstruction Using Autograft Tendons: In Vivo Three-Dimensional Imaging Analysis

    PubMed Central

    Yang, Jae-Hyuk; Chang, Minho; Kwak, Dai-Soon

    2014-01-01

    Background Regarding reconstruction surgery of the anterior cruciate ligament (ACL), there is still a debate whether to perform a single bundle (SB) or double bundle (DB) reconstruction. The purpose of this study was to analyze and compare the volume and surface area of femoral and tibial tunnels during transtibial SB versus transportal DB ACL reconstruction. Methods A consecutive series of 26 patients who underwent trantibial SB ACL reconstruction and 27 patients with transportal DB ACL reconstruction using hamstring autograft from January 2010 to October 2010 were included in this study. Three-dimensional computed tomography (3D-CT) was taken within one week after operation. The CT bone images were segmented with use of Mimics software v14.0. The obtained digital images were then imported in the commercial package Geomagic Studio v10.0 and SketchUp Pro v8.0 for processing. The femoral and tibial tunnel lengths, diameters, volumes and surface areas were evaluated. A comparison between the two groups was performed using the independent-samples t-test. A p-value less than the significance value of 5% (p < 0.05) was considered statistically significant. Results Regarding femur tunnels, a significant difference was not found between the tunnel volume for SB technique (1,496.51 ± 396.72 mm3) and the total tunnel volume for DB technique (1,593.81 ± 469.42 mm3; p = 0.366). However, the total surface area for femoral tunnels was larger in DB technique (919.65 ± 201.79 mm2) compared to SB technique (810.02 ± 117.98 mm2; p = 0.004). For tibia tunnels, there was a significant difference between tunnel volume for the SB technique (2,070.43 ± 565.07 mm3) and the total tunnel volume for the DB technique (2,681.93 ± 668.09 mm3; p ? 0.001). The tibial tunnel surface area for the SB technique (958.84 ± 147.50 mm2) was smaller than the total tunnel surface area for the DB technique (1,493.31 ± 220.79 mm2; p ? 0.001). Conclusions Although the total femoral tunnel volume was similar between two techniques, the total surface area was larger in the DB technique. For the tibia, both total tunnel volume and the surface area were larger in DB technique. PMID:25177454

  15. Inducement of semitendinosus tendon regeneration to the pes anserinus after its harvest for anterior cruciate ligament reconstruction-A new inducer grafting technique

    PubMed Central

    2012-01-01

    Purpose To investigate the usefulness of the “inducer grafting” technique for regeneration of the semitendinosus (ST) tendon after its harvest for anterior cruciate ligament (ACL) reconstruction. Methods Twenty knees of 20 patients (mean age at the time of surgery, 23.1?years) underwent ACL reconstruction with a double bundle autograft using the ST tendon (7 patients) and the ST + the gracilis (G) tendons (13 patients). “Inducer grafting” technique After harvesting the ST tendon, a passing pin with a loop thread is inserted along with the tendon stripper. The passing pin is pulled out from the medial thigh and the loop thread retained. As an inducer graft, the ST tendon branch is used. After the ACL graft has been secured, the inducer graft is sutured to the pes anserinus and the proximal end passed through by pulling the thread out. Then the inducer graft is placed within the tendon canal. The mean follow-up period was 15?months. The presence and morphology of the regenerated ST tendon were examined by MRI. And the isometric hamstring strength was examined at 45°, 90° and 120° of knee flexion. Results One month after the operation in all the patients, MRI demonstrated a low-intensity structure at the anatomical location of the ST, at the level of the superior pole of the patella and the joint line, apparently representing the regenerated ST tendon. Four months after the operation, the distal portion of the regenerated ST tendon had reached the pes anserinus in all patients. Twelve months after the operation, the regenerated ST tendon was hypertrophic in 19 of the 20 patients (95%). The isometric knee flexion torque of the ACL-reconstructed limb was significantly lower at 90° and 120° compared with the contralateral limb. Conclusion These results suggest that the “inducer grafting” technique is able to improve the regeneration rate of the harvested ST tendon and promote hypertrophy of the regenerated ST tendon, extending all the way to the pes anserinus. However, this technique couldn’t improve the deficits in knee flexion torque after ACL reconstruction. PMID:22607724

  16. Identification of Suitable Reference Genes for Investigating Gene Expression in Anterior Cruciate Ligament Injury by Using Reverse Transcription-Quantitative PCR

    PubMed Central

    Leal, Mariana Ferreira; Astur, Diego Costa; Debieux, Pedro; Arliani, Gustavo Gonçalves; Franciozi, Carlos Eduardo Silveira; Loyola, Leonor Casilla; Andreoli, Carlos Vicente; Smith, Marília Cardoso; Pochini, Alberto de Castro; Ejnisman, Benno; Cohen, Moises

    2015-01-01

    The anterior cruciate ligament (ACL) is one of the most frequently injured structures during high-impact sporting activities. Gene expression analysis may be a useful tool for understanding ACL tears and healing failure. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) has emerged as an effective method for such studies. However, this technique requires the use of suitable reference genes for data normalization. Here, we evaluated the suitability of six reference genes (18S, ACTB, B2M, GAPDH, HPRT1, and TBP) by using ACL samples of 39 individuals with ACL tears (20 with isolated ACL tears and 19 with ACL tear and combined meniscal injury) and of 13 controls. The stability of the candidate reference genes was determined by using the NormFinder, geNorm, BestKeeper DataAssist, and RefFinder software packages and the comparative ?Ct method. ACTB was the best single reference gene and ACTB+TBP was the best gene pair. The GenEx software showed that the accumulated standard deviation is reduced when a larger number of reference genes is used for gene expression normalization. However, the use of a single reference gene may not be suitable. To identify the optimal combination of reference genes, we evaluated the expression of FN1 and PLOD1. We observed that at least 3 reference genes should be used. ACTB+HPRT1+18S is the best trio for the analyses involving isolated ACL tears and controls. Conversely, ACTB+TBP+18S is the best trio for the analyses involving (1) injured ACL tears and controls, and (2) ACL tears of patients with meniscal tears and controls. Therefore, if the gene expression study aims to compare non-injured ACL, isolated ACL tears and ACL tears from patients with meniscal tear as three independent groups ACTB+TBP+18S+HPRT1 should be used. In conclusion, 3 or more genes should be used as reference genes for analysis of ACL samples of individuals with and without ACL tears. PMID:26192306

  17. INTRA AND INTERSESSION RELIABILITY OF A POSTURAL CONTROL PROTOCOL IN ATHLETES WITH AND WITHOUT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A DUAL?TASK PARADIGM

    PubMed Central

    Mohammadirad, Shahrzad; Salavati, Mahyar; Takamjani, Ismail Ebrahimi; Sherafat, Shiva; Mazaheri, Masood; Negahban, Hossein

    2012-01-01

    Background: Quantification of dynamic balance is essential to assess a patient's level of injury or ability to function so that a proper plan of care may commence. In spite of comprehensive utilization of dual?tasking in balance assessment protocols, a lack of sufficient reliability data is apparent. Purpose: The purpose of the present study was to determine the intra? and inter?session reliability of dynamic balance measures obtained using the Biodex Balance System® (BBS) for a group of athletes who had undergone anterior cruciate ligament reconstruction (ACLR) and a matched control group without ACLR, while using a dual?task paradigm. Methods: Single?limb postural stability was assessed in 15 athletes who had undergone ACLR and 15 healthy matched controls. The outcome variables included measures of both postural and cognitive performance. For measuring postural performance, the overall stability index (OSI), anterior?posterior stability index (APSI), and medial?lateral stability index (MLSI), were recorded. Cognitive performance was evaluated by measuring error ratio and average reaction time. Subjects faced 4 postural task difficulty levels (platform stabilities of 8 and 6 with eyes open and closed), and 2 cognitive task difficulty levels (with or without auditory Stroop task). During dual task conditions (conditions with Stroop task), error ratio and average reaction time were calculated. Results: Regarding intrasession reliability, ICC values of test session were higher for MLSI [ACL?R group (0.83?0.95), control group (0.71?0.95)] compared to OSI [ACL?R group (0.80?0.92), control group (0.67?0.95)] and APSI [ACL?R group (0.73?0.90), control group (0.62?0.90)]. Furthermore, ICC values of first test session were higher in reaction time [ACL?R group (0.92?0.95), control group (0.80?0.92)] than error ratio [ACL?R group (0.72?0.88), control group (0.61?0.83)]. ICC values of retest session were higher for MLSI [ACL?R group (0.83?0.94), control group (0.87?0.93)] than OSI [ACL?R group (0.81?0.91), control group (0.83?0.93)] and APSI [ACL?R group (0.73?0.90), control group (0.53?0.90)]. Moreover, ICC values of retest session were higher in reaction time [ACL?R group (0.89?0.98), control group (0.80?0.92)] equated with error ratio [ACL?R group (0.73?0.87), control group (0.57?0.79)]. With respect to intersession reliability, ICC values were higher for MLSI [ACL?R group (0.72?0.96), control group (0.75?0.92)] than OSI [ACL?R group (0.55?0.91), control group (0.64?0.87)] and APSI [ACL?R group (0.55?0.79), control group (0.46?0.89)]. Additionally, ICC values were higher in reaction time [ACL?R group (0.87?0.95), control group (0.68?0.81)] in contrast to error ratio [ACL?R group (0.42?0.64), control group (0.54?0.74)]. Conclusion: Biodex Balance System® measures of postural stability demonstrated moderate to high reliability in athletes with and without ACLR during dual?tasking. Results of the current study indicated that assessment of postural and cognitive performance in athletes with ACLR may be reliably incorporated into the evaluation of functional activity. Level of Evidence: 2b PMID:23316426

  18. Clinical comparison of the Autologous Quadriceps Tendon (BQT) and the Autologous Patella Tendon (BPTB) for the reconstruction of the Anterior Cruciate Ligament

    Microsoft Academic Search

    O. Gorschewsky; A. Klakow; A. Pütz; H. Mahn; W. Neumann

    2007-01-01

    The use of the BPTB-autograft is a very common method for ACL reconstruction. Nevertheless, the problem of the typical donor-site-morbidity\\u000a is unresolved. Recently, a transplant of quadriceps tendon, with an attached bone block (BQT) has been increasingly relied\\u000a upon. The purpose of this study was to examine the clinical results of a group of patients after arthroscopic ACL reconstruction\\u000a using

  19. Enhancement of tendon-bone healing for anterior cruciate ligament (ACL) reconstruction using bone marrow-derived mesenchymal stem cells infected with BMP-2.

    PubMed

    Dong, Yu; Zhang, Qingguo; Li, Yunxia; Jiang, Jia; Chen, Shiyi

    2012-01-01

    At present, due to the growing attention focused on the issue of tendon-bone healing, we carried out an animal study of the use of genetic intervention combined with cell transplantation for the promotion of this process. Here, the efficacy of bone marrow stromal cells infected with bone morphogenetic protein-2 (BMP-2) on tendon-bone healing was determined. A eukaryotic expression vector containing the BMP-2 gene was constructed and bone marrow-derived mesenchymal stem cells (bMSCs) were infected with a lentivirus. Next, we examined the viability of the infected cells and the mRNA and protein levels of BMP-2-infected bMSCs. Gastrocnemius tendons, gastrocnemius tendons wrapped by bMSCs infected with the control virus (bMSCs+Lv-Control), and gastrocnemius tendons wrapped by bMSCs infected with the recombinant BMP-2 virus (bMSCs+Lv-BMP-2) were used to reconstruct the anterior cruciate ligament (ACL) in New Zealand white rabbits. Specimens from each group were harvested four and eight weeks postoperatively and evaluated using biomechanical and histological methods. The bMSCs were infected with the lentivirus at an efficiency close to 100%. The BMP-2 mRNA and protein levels in bMSCs were significantly increased after lentiviral infection. The bMSCs and BMP-2-infected bMSCs on the gastrocnemius tendon improved the biomechanical properties of the graft in the bone tunnel; specifically, bMSCs infected with BMP-2 had a positive effect on tendon-bone healing. In the four-week and eight-week groups, bMSCs+Lv-BMP-2 group exhibited significantly higher maximum loads of 29.3 ± 7.4 N and 45.5 ± 11.9 N, respectively, compared with the control group (19.9 ± 6.4 N and 21.9 ± 4.9 N) (P = 0.041 and P = 0.001, respectively). In the eight-week groups, the stiffness of the bMSCs+Lv-BMP-2 group (32.5 ± 7.3) was significantly higher than that of the bMSCs+Lv-Control group (22.8 ± 7.4) or control groups (12.4 ± 6.0) (p = 0.036 and 0.001, respectively). Based on the histological findings, there was an increased amount of perpendicular collagen fibers formed between the tendon and bone in the bMSCs+Lv-Control and bMSCs+Lv-BMP-2 group, compared with the gastrocnemius tendons. The proliferation of cartilage-like cells and the formation of fibrocartilage-like tissue were highest within the bone tunnels in the bMSCs+Lv-BMP-2 group. These results suggest that this lentivirus can be used to efficiently infect bMSCs with BMP-2. Furthermore, tendons wrapped by bMSCs+Lv-BMP-2 improved tendon-bone healing. PMID:23202970

  20. [Reconstruction of the cruciate ligaments with allogeneic transplants. Techniques, results and perspectives].

    PubMed

    Marks, P H; Cameron, M; Fu, F H

    1993-11-01

    The authors have used allografts for reconstruction of the cruciate ligaments in over 600 cases since 1985. Advantages are the reduced operative trauma and the unlimited availability of high-quality grafts even in multiple ligament reconstructions. Arthroscopic techniques are available for reconstruction of the anterior and the posterior cruciate ligament, which makes arthrotomies and large skin incisions unnecessary. The grafts of choice are the bone-patellar tendon-bone preparation and the Achilles tendon with bone bloc. No specific complications were observed with the use of allograft material in this series. Results show a high subjective acceptance of the procedure among the patients, with a high rate of return to pre-injury sports activities following ACL reconstruction. Objective stability was restored in over 70% of these cases. All cases with posterior instability had 3+ posterior drawer preoperatively. At follow-up, almost normal stability had been restored in 50%. Further research must focus on the biological processes that take place during incorporation of these tissues and on better techniques of graft processing and sterilisation. At present, the risk of disease transmission must be considered and discussed with the patient. PMID:8309698

  1. Tibial inlay technique with quadriceps tendon-bone autograft for posterior cruciate ligament reconstruction

    Microsoft Academic Search

    Tai-Yuan Chuang; Chih-Hwa Chen; Shih-Wei Chou; Yeung-Jen Chen; Wen-Jer Chen

    2004-01-01

    Surgical reconstruction of the posterior cruciate ligament (PCL) is indicated in a PCL-deficient knee with symptomatic instability and injury to other ligaments. However, the choice of graft tissues remains controversial. The tibial inlay method has the benefit of preventing the acute turn associated with transtibial reconstruction and permitting accurate anatomic placement of the graft. This study describes an arthroscopic-assisted inlay

  2. Prospective Clinical Comparisons of Anatomic Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction Procedures in 328 Consecutive Patients

    Microsoft Academic Search

    Eiji Kondo; Kazunori Yasuda; Hirotaka Azuma; Yoshie Tanabe; Tomonori Yagi

    Results: No serious complications were experienced in either group. The anterior laxity was significantly less in the double- bundle reconstruction (mean, 1.2 mm) than in the single-bundle reconstruction (mean, 2.5 mm). In the pivot-shift test, the double bundle (+ indication, 16%; ++, 3%) was significantly better than the single bundle (+ result, 37%; ++, 12%). The mean Lysholm score averaged

  3. A canine hybrid double-bundle model for study of arthroscopic ACL reconstruction.

    PubMed

    Cook, James L; Smith, Patrick A; Stannard, James P; Pfeiffer, Ferris M; Kuroki, Keiichi; Bozynski, Chantelle C; Cook, Cristi R

    2015-08-01

    Development and validation of a large animal model for pre-clinical studies of intra-articular anterior cruciate ligament (ACL) reconstruction that addresses current limitations is highly desirable. The objective of the present study was to investigate a translational canine model for ACL reconstruction. With institutional approval, adult research hounds underwent arthroscopic debridement of the anteromedial bundle (AMB) of the ACL, and then either received a tendon autograft for "hybrid double-bundle" ACL reconstruction (n?=?12) or no graft to remain ACL/AMB-deficient (n?=?6). Contralateral knees were used as non-operated controls (n?=?18) and matched canine cadaveric knees were used as biomechanical controls (n?=?6). Dogs were assessed using functional, diagnostic imaging, gross, biomechanical, and histologic outcome measures required for pre-clinical animal models. The data suggest that this canine model was able to overcome the major limitations of large animal models used for translational research in ACL reconstruction and closely follow clinical aspects of human ACL reconstruction. The "hybrid double-bundle" ACL reconstruction allowed for sustained knee function without the development of osteoarthritis and for significantly improved functional, diagnostic imaging, gross, biomechanical, and histologic outcomes in grafted knees compared to ACL/AMB-deficient knees. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1171-1179, 2015. PMID:25763560

  4. Arthroscopically assisted acromioclavicular joint reconstruction.

    PubMed

    Baumgarten, Keith M; Altchek, David W; Cordasco, Frank A

    2006-02-01

    Arthroscopically assisted acromioclavicular joint reconstruction avoids the large incisions necessary with open reconstructions. This acromioclavicular joint reconstruction technique via the subacromial space does not violate the rotator interval or require screw removal. The patient is placed in a modified beach-chair position. The arthroscope is placed into the subacromial space, and a bursectomy is performed through a lateral subacromial portal. The coracoacromial ligament is released from the acromion with an electrocautery and an arthroscopic elevator. A nonabsorbable suture is passed through the coracoacromial ligament with a suture passer, and an arthroscopic suture grasper is used to deliver both ends of the suture out through the lateral portal. The coracoid is identified and isolated using a radiofrequency ablator placed through the anterior portal while visualizing through the lateral portal. A percutaneous shuttle device is passed through the skin superomedial to the coracoid. The shuttle is visualized entering superior to the coracoid and is passed just medial to the coracoid. Once the tip of the shuttle can be visualized in the recess inferior to the coracoid, the shuttle loop is advanced. A suture grasper is used to deliver both ends of the shuttle out through the anterior portal. A semitendinosus allograft is used to reconstruct the coracoclavicular ligament. A nonabsorbable suture is passed through both ends of the allograft. Three strands of nonabsorbable suture are braided together. The tendon and the braided suture are shuttled around the coracoid. At this point, both the braided suture and the allograft tendon enter the anterior portal, wrap around the coracoid base, and exit the anterior portal. A 3-cm incision is made over the distal clavicle. A hole is drilled through the clavicle with a 5-mm drill. A loop of 22-gauge wire is passed through the hole in the clavicle, and a looped suture is shuttled through the hole. A curved clamp is used to create a tunnel from the acromioclavicular joint, under the deltoid, to the anterior portal. The ends of the braided suture and the tendon sutures are grasped by the clamp and pulled out the acromioclavicular joint incision. The limbs of the braided suture and the tendon suture that pass medial to the coracoid are shuttled through the hole in the clavicle using the looped suture that was previously passed through the clavicle. The acromioclavicular joint is reduced by pushing down on the distal clavicle with a bone tamp while simultaneously lifting the acromion upward by superiorly loading the humerus at the elbow. Once the acromioclavicular joint is reduced or slightly over-reduced, the braided suture is tied down securely. The acromioclavicular joint should remain reduced even after the manual reduction maneuver is released. The semitendinosus allograft is tensioned around the distal end of the clavicle and sutured to itself with a nonabsorbable suture. The released coracoacromial ligament is retrieved from the clavicular incision and sutured to the distal clavicle and semitendinosus allograft. The incision is closed in standard fashion, and a sling is applied. PMID:16458813

  5. Arthroscopic lateral ankle stabilization.

    PubMed

    Kashuk, K B; Landsman, A S; Werd, M B; Hanft, J R; Roberts, M

    1994-07-01

    The indications for arthroscopic stabilization include those patients with isolated ruptures or strains of the ATF. The procedure is particularly convenient for patients with ankle joint pathology that is already most commonly treated arthroscopically, such as chronic instability, in which inflamed synovium or meniscoid bodies are to be excised. Although significant stability can be gained with this technique, injuries that result in damage to the calcaneofibular ligament may require additional open surgery, since this ligament cannot be visualized arthroscopically. However, the anchoring techniques described in this article can still be used when performing open surgery. PMID:7954209

  6. The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee injuries

    Microsoft Academic Search

    Jerald W. Katz; Richard J. Fingeroth

    1986-01-01

    Eighty-five patients with knee injuries were included in a 4 month retrospective study that compared the rela tive accuracy of the Lachman test, the anterior drawer sign, and the pivot shift test. All examinations were performed under anesthesia and followed by arthros copy, which confirmed 22 injuries. Of all ACL injuries occurring within 2 weeks of arthroscopy (N = 9),

  7. Test-retest reliability [corrected] of center of pressure measures of postural stability during quiet standing in a group with musculoskeletal disorders consisting of low back pain, anterior cruciate ligament injury and functional ankle instability.

    PubMed

    Salavati, Mahyar; Hadian, Mohammad Reza; Mazaheri, Masood; Negahban, Hossein; Ebrahimi, Ismaeil; Talebian, Saeed; Jafari, Amir Homayoun; Sanjari, Mohammad Ali; Sohani, Soheil Mansour; Parnianpour, Mohamad

    2009-04-01

    Reliability is a population-specific property, but to the authors' knowledge there has been no study to determine the test-retest reliability of the postural stability measures such as center of pressure (COP) measures in the population of patients with musculoskeletal disorders (MSDs), while their clinical applications have been presented in literature. So, 33 patients with low back pain (LBP), anterior cruciate ligament (ACL) injury and functional ankle instability (FAI) randomly completed postural measurements with three levels of difficulty (rigid surface-eyes open, rigid surface-eyes closed, and foam surface-eyes closed) in two sessions. COP data were used to calculate standard deviation of amplitude, standard deviation of velocity, phase plane portrait, mean total velocity and area (95% confidence ellipse). Relative reliability of these measures was assessed using intraclass correlation coefficient (ICC) and absolute reliability using standard error of measurement (SEM) and coefficient of variation (CV). Also, minimal metrically detectable change (MMDC) was calculated to quantify intervention effects. Among different COP parameters, mean total velocity in all conditions of postural difficulty showed high to very high reliability, with ICC range of 0.74-0.91, SEM range of 0.09-0.40cm/s, CV range of 5.31-8.29% and MMDC range of 0.19-0.79cm/s. Phase plane portrait in anteroposterior-mediolateral (AP-ML) and ML direction were other best parameters with respect to the level of reliability. Mean total velocity and phase plane portrait parameters are suggested as good candidates to use for quantification and assessment of balance performance and identifying those with MSDs. PMID:19167891

  8. Arthroscopic release for lateral epicondylitis

    Microsoft Academic Search

    Brett D. Owens; Kevin P. Murphy; Timothy R. Kuklo

    2001-01-01

    Purpose: This study was performed to review the results of our early experience with recalcitrant lateral epicondylitis treated arthroscopically. Type of Study: This study is a case series consisting of consecutive patients with lateral epicondylitis treated arthroscopically by 1 surgeon. Methods: Patients failing a minimum of 6 months of conservative treatment underwent arthroscopic release of the extensor carpi radialis brevis

  9. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury?

    PubMed Central

    Myer, Gregory D; Ford, Kevin R; Di Stasi, Stephanie L; Foss, Kim D Barber; Micheli, Lyle J; Hewett, Timothy E

    2014-01-01

    Background Identifying risk factors for knee pain and anterior cruciate ligament (ACL) injury can be an important step in the injury prevention cycle. Objective We evaluated two unique prospective cohorts with similar populations and methodologies to compare the incidence rates and risk factors associated with patellofemoral pain (PFP) and ACL injury. Methods The ‘PFP cohort’ consisted of 240 middle and high school female athletes. They were evaluated by a physician and underwent anthropometric assessment, strength testing and three-dimensional landing biomechanical analyses prior to their basketball season. 145 of these athletes met inclusion for surveillance of incident (new) PFP by certified athletic trainers during their competitive season. The ‘ACL cohort’ included 205 high school female volleyball, soccer and basketball athletes who underwent the same anthropometric, strength and biomechanical assessment prior to their competitive season and were subsequently followed up for incidence of ACL injury. A one-way analysis of variance was used to evaluate potential group (incident PFP vs ACL injured) differences in anthropometrics, strength and landing biomechanics. Knee abduction moment (KAM) cut-scores that provided the maximal sensitivity and specificity for prediction of PFP or ACL injury risk were also compared between the cohorts. Results KAM during landing above 15.4 Nm was associated with a 6.8% risk to develop PFP compared to a 2.9% risk if below the PFP risk threshold in our sample. Likewise, a KAM above 25.3 Nm was associated with a 6.8% risk for subsequent ACL injury compared to a 0.4% risk if below the established ACL risk threshold. The ACL-injured athletes initiated landing with a greater knee abduction angle and a reduced hamstrings-to-quadriceps strength ratio relative to the incident PFP group. Also, when comparing across cohorts, the athletes who suffered ACL injury also had lower hamstring/quadriceps ratio than the players in the PFP sample (p<0.05). Conclusions In adolescent girls aged 13.3 years, >15 Nm of knee abduction load during landing is associated with greater likelihood of developing PFP. Also, in girls aged 16.1 years who land with >25 Nm of knee abduction load during landing are at increased risk for both PFP and ACL injury. PMID:24687011

  10. Structure and vascularization of the cruciate ligaments of the human knee joint

    Microsoft Academic Search

    Wolf Petersen; Bernhard Tillmann

    1999-01-01

    The structure and vascularization of the human anterior and posterior cruciate ligament were investigated by light microscopy,\\u000a transmission electron microscopy, injection techniques and by immunohistochemistry. The major part of the anterior and posterior\\u000a cruciate ligament is composed of bundles of type I collagen. Type III collagen-positive fibrils separate the bundles. The\\u000a major cell type is the elongated fibroblast, lying solitarily

  11. Spatial Change of Cruciate Ligaments in Rat Embryo Knee Joint by Three-Dimensional Reconstruction

    PubMed Central

    Zhang, Xiangkai; Aoyama, Tomoki; Takaishi, Ryota; Higuchi, Shinya; Yamada, Shigehito; Kuroki, Hiroshi; Takakuwa, Tetsuya

    2015-01-01

    This study aimed to analyze the spatial developmental changes of rat cruciate ligaments by three-dimensional (3D) reconstruction using episcopic fluorescence image capture (EFIC). Cruciate ligaments of Wister rat embryos between embryonic day (E) 16 and E20 were analyzed. Samples were sectioned and visualized using EFIC. 3D reconstructions were generated using Amira software. The length of the cruciate ligaments, distances between attachment points to femur and tibia, angles of the cruciate ligaments and the cross angle of the cruciate ligaments were measured. The shape of cruciate ligaments was clearly visible at E17. The lengths of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) increased gradually from E17 to E19 and drastically at E20. Distances between attachment points to the femur and tibia gradually increased. The ACL angle and PCL angle gradually decreased. The cross angle of the cruciate ligaments changed in three planes. The primordium of the 3D structure of rat cruciate ligaments was constructed from the early stage, with the completion of the development of the structures occurring just before birth. PMID:26098761

  12. Posterior Cruciate Ligament Revision Reconstruction, Part 2Results of Revision Using a 2Strand Quadriceps Tendon–Patellar Bone Autograft

    Microsoft Academic Search

    Frank R. Noyes; Sue D. Barber-Westin

    2005-01-01

    Background: Posterior cruciate ligament reconstructions fail for similar reasons as to why anterior cruciate ligament reconstructions fail. Revision surgery is an option after failure.Purpose: To prospectively study the results of 15 posterior cruciate ligament revision surgeries using a 2-strand quadriceps tendon–patellar bone autograft.Study Design: Case series; Level of evidence, 4.Methods: The authors observed 15 knees that received the revision procedure

  13. Validity of instrumented measurement of anterior laxity of the knee at different force levels

    Microsoft Academic Search

    T Siebel; F Geiger; D Pöhlmann; J Heisel

    1995-01-01

    The Kneelax arthrometer is a tibia referenced sytem for objectively testing and reproducing the anterior stability of the anterior cruciate ligament (ACL). It measures the extent of anterior translation of the tibia on the femur, under anterior drawer forces of 44, 67, 89, and 132 N. The compliance of the system, calculated as the increase in anterior displacement between the

  14. Complications in brief: Anterior cruciate ligament reconstruction.

    PubMed

    Tjoumakaris, Fotios Paul; Herz-Brown, Amy L; Bowers, Andrea L; Legath-Bowers, Andrea; Sennett, Brian J; Bernstein, Joseph

    2012-02-01

    When performing reconstruction of the ACL, the major complications that can arise include missed concomitant injuries, tunnel malposition, patellar fracture, knee stiffness, and infection. We review the complications that can occur as a result of errors made before, during, and after surgery. PMID:22086506

  15. Physiotherapy after reconstruction of anterior cruciate ligament

    PubMed Central

    Pereira, Maitê; Vieira, Neiva de Souza; Brandão, Eduardo da Rosa; Ruaro, João Afonso; Grignet, Rodrigo Juliano; Fréz, Andersom Ricardo

    2012-01-01

    The purpose of this study was to evaluate the existence of differences in the rehabilitation of patients after ACL reconstruction using bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts, through a literature revision. The researched databases were MEDLINE, EMBASE, LILACS, COCHRANE and PEDro. The inclusion criteria were published studies with methodology draw from randomized clinical trials with or without meta-analysis, individuals with ACL injury, associated or not to meniscal injury, submitted to ligamentoplasty using the bone-patellar tendon-bone graft and the four-strand semitendinosus and gracilis tendon grafts and physiotherapy; clinical trials comparing the differences in the rehabilitation of these patients, in Portuguese, English and Spanish, from 1990 to June, 2011. Five clinical trials were reviewed. No difference was observed between the techniques, however, with a recommendation for a less aggressive rehabilitation and greater attention to the strengthening of the hamstring when they are used as grafts. PMID:24453634

  16. Anterior cruciate ligament repair - series (image)

    MedlinePLUS

    ... removed using a shaver or other instruments. Bone tunnels are made to place the new ligament (patellar ... used to secure the graft in the bone tunnels, although other methods of fixation are used depending ...

  17. Arthroscopic tennis elbow release.

    PubMed

    Savoie, Felix H; O'Brien, Michael J

    2015-01-01

    Lateral epicondylitis, originally referred to as tennis elbow, affects between 1% and 3% of the population and is usually found in patients aged 35 to 50 years. Although it was initially thought that lateral epicondylitis was caused by an inflammatory process, most microscopic studies of excised tissue demonstrate a failure of reparative response in the extensor carpi radialis brevis tendon and in any of the associated structures. Most cases of lateral epicondylitis respond to appropriate nonsurgical treatment protocols, which include medication, bracing, physical therapy, corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal or ultrasound ablation devices. However, when these protocols are unsuccessful, surgical measures may be appropriate and have a high rate of success. The results of arthroscopic surgical procedures have documented satisfactory results, with improvement rates reported between 91% and 97.7%. Recent advances in arthroscopic repair and plication of these lesions, along with recognizing the presence and repair of coexisting lesions, have allowed arthroscopic techniques to provide excellent results. PMID:25745908

  18. Arthroscopic ankle arthrodesis.

    PubMed

    Tasto, J P; Frey, C; Laimans, P; Morgan, C D; Mason, R J; Stone, J W

    2000-01-01

    The obvious socioeconomic advantages are quite dramatic, with early weight-bearing and AFO immobilization allowing patients an early return to work. Outpatient surgery is a cost-effective benefit. Patient satisfactions as well as comfort are greatly enhanced, requiring only oral pain medication. All patients have tolerated their postoperative regimen and same-day discharge. Arthroscopic subtalar arthrodesis is a technically demanding procedure that requires some rather advanced arthroscopic skills to perform. Joint access is tight, restricted, and requires small instrumentation. Deformities cannot be corrected; therefore, at this stage, a fusion in situ must be considered. The learning curve is certainly far steeper because of the smaller patient population available for enhancing surgical skills. Overall, this procedure has stood the test of time and follow-up. The results appear to be excellent in terms of patient satisfaction, fusion rate time until union, and postoperative morbidity. The recognition and enhancement of this technique as well as the development of more advanced technology will certainly allow this arthroscopic subtalar arthrodesis technique to mature even further over time. PMID:10829182

  19. Gait analysis after total knee arthroplasty. Comparison of posterior cruciate retention and substitution

    Microsoft Academic Search

    Yoshinori Ishii; Kazuhiro Terajima; Yoshio Koga; Hideaki E. Takahashi; Joan E. Bechtold; Ramon B. Gustilo

    1998-01-01

    :   The objective of this study was to measure three-dimensional knee motion during gait in patients with total knee replacements\\u000a which either retained the posterior cruciate ligament (n = 11), or required sacrifice of the posterior cruciate ligament and replacement of its function with a posterior stabilizing\\u000a articular surface (n = 9). Clinically meaningful translations (anterior and posterior, medial and

  20. Histology and Arthroscopic Anatomy of the Ulnar Collateral Ligament of the Elbow

    Microsoft Academic Search

    Laura A. Timmerman; James R. Andrews

    1994-01-01

    The histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow were studied in cadav eric specimens. The capsule consists of two layers of collagen fibers, with two distinct ligamentous bundles corresponding to anterior and posterior portions of the ulnar collateral ligament. The posterior bundle consists of distinct collagen bundles within the layers of the cap sule ;

  1. Advantages of 70° arthroscope in management of ECRB tendinopathy.

    PubMed

    Arrigoni, P; Zottarelli, L; Spennacchio, P; Denti, M; Cabitza, P; Randelli, P

    2011-07-01

    Lateral epicondylitis requires a challenging therapeutic management even for expert surgeons. With the failure of conservative treatment, the physician should consider a surgical choice. The purpose of the surgical procedure is to excise the degenerated tissue of extensor carpi radialis brevis tendon. This article describes the arthroscopic release, performed under direct visualization with a 70° scope; the aim is to encourage the use of this type of lens, versus the traditional 30° one. The patient is positioned in a modified lateral decubitus. After joint distension, a diagnostic arthroscopy of the posterior compartment is performed as first step. Then, an anterior compartment arthroscopic evaluation, a subsequent antero-lateral capsulectomy, and extensor carpi radialis brevis tendon exposition are performed with a 30° view. At this point, the 70° lens is switched and the tendon release is performed under direct control. The 70° lens allows a safer procedure, but requires a dedicated learning curve. PMID:21484442

  2. Arthroscopic treatment of an aneurysmal bone cyst of the patella: A case report

    PubMed Central

    Sandokji, Abdullah

    2015-01-01

    Aneurysmal bone cyst is a benign tumor-like bone lesion. This report concerns a 43 year-old male patient diagnosed with a primary aneurysmal bone cyst of his right patella. His main presentation was anterior knee pain. The patient was treated with arthroscopic excisional biopsy of the cyst and curettage, followed by filling the cavity with bone cement at a second stage. During the 5-year follow-up, the patient remained symptom free, with a normal range of motion. The arthroscopic approach is a less-invasive procedure with low morbidity and enabled us to determine which site should be going through. PMID:25901136

  3. Arthroscopic Broström repair with Gould augmentation via an accessory anterolateral port for lateral instability of the ankle.

    PubMed

    Matsui, Kentaro; Takao, Masato; Miyamoto, Wataru; Innami, Ken; Matsushita, Takashi

    2014-10-01

    Although several arthroscopic surgical techniques for the treatment of lateral instability of the ankle have been introduced recently, some concern remains over their procedural complexity, complications, and unclear clinical outcomes. We have simplified the arthroscopic technique of Broström repair with Gould augmentation. This technique requires only two small skin incisions for two ports (medial midline and accessory anterolateral ports), without needing a percutaneous procedure or extension of the skin incisions. The anterior talofibular ligament is reattached to its anatomical footprint on the fibula with suture anchor, under arthroscopic view. The inferior extensor retinaculum is directly visualized through the accessory anterolateral port and is attached to the fibula with another suture anchor under arthroscopic view via the anterolateral port. The use of two small ports offers a procedure that is simple to perform and less morbid for patients. PMID:25015792

  4. Anterior ankle arthroscopy: indications, pitfalls, and complications.

    PubMed

    Epstein, David M; Black, Brandee S; Sherman, Seth L

    2015-03-01

    Anterior ankle arthroscopy is a useful, minimally invasive technique for diagnosing and treating ankle conditions. Arthroscopic treatment offers the benefit of decreased surgical morbidity, less postoperative pain, and earlier return to activities. Indications for anterior ankle arthroscopy continue to expand, including ankle instability, impingement, management of osteochondritis dissecans, synovectomy, and loose body removal. Anterior ankle arthroscopy has its own set of inherent risks and complications. Surgeons can decrease the risk of complications through mastery of ankle anatomy and biomechanics, and by careful preoperative planning and meticulous surgical technique. PMID:25726482

  5. Fiber-optics couple arthroscope to TV

    NASA Technical Reports Server (NTRS)

    Franke, J. M.; Rhodes, D. B.

    1981-01-01

    Convenient, hand-held coupler images output of arthroscope onto coherent fiber bundle. Arthroscope allows surgeons to examine internal organs through any small opening in body. Coupler is also used for engine inspection, instrument repair, and around-corner visual inspection. Image from arthroscope travels along flexible bundle and appears at other cable end where it is recollimated by lens. Image is read from lens or projected on color TV camera.

  6. Posterior cruciate ligament removal contributes to abnormal knee motion during posterior stabilized total knee arthroplasty

    Microsoft Academic Search

    Melinda J. Cromie; Robert A. Siston; Nicholas J. Giori; Scott L. Delp

    2008-01-01

    Abnormal anterior translation of the femur on the tibia has been observed in mid flexion (20-608) following posterior stabilized total knee arthroplasty. The underlying biomechanical causes of this abnormal motion remain unknown. The purpose of this study was to isolate the effects of posterior cruciate ligament removal on knee motion after total knee arthroplasty. We posed two questions: Does removing

  7. Augmented Virtuality for Arthroscopic Knee Surgery

    E-print Network

    Stewart, James

    Augmented Virtuality for Arthroscopic Knee Surgery John M. Li1 , Davide D. Bardana2 , A. James residents. 1 Introduction Arthroscopic knee surgery is a minimally invasive procedure in which the surgeon open surgery. However, navigating within the joint is challenging because the camera image

  8. Intra-articular analgesia for arthroscopic meniscectomy

    Microsoft Academic Search

    B. LYONS; D. LOHAN; C. G. FLYNN; G. P. JOSHI; T. M. O'BRIEN; M. MCCARROLL

    Summary Intra-articular morphine has been shown to provide prolonged analgesia after arthroscopic knee sur- gery; the addition of local anaesthetic agents has been reported to improve this analgesic effect. Pethidine possesses local anaesthetic properties, and therefore this study was designed to evaluate its analgesic efficacy after arthroscopic meniscectomy. Sixty patients were allocated randomly to receive intra-articular injections of pethidine 50

  9. Arthroscopic reconstruction for acromioclavicular joint dislocation

    Microsoft Academic Search

    Eugene M Wolf; William T Pennington

    2001-01-01

    We describe an arthroscopic reconstruction technique for acromioclavicular joint dislocation. Subsequent to Baum’s first repair of the coracoclavicular complex in 1886, over 60 operative procedures have been described in the literature. This procedure is the first described arthroscopic approach used in reconstruction for acromioclavicular dislocation. It provides an anatomically correct and structurally sound reconstruction of the coracoclavicular ligament complex. This

  10. Arthroscopy of the subtalar joint and arthroscopic subtalar arthrodesis.

    PubMed

    Tasto, James P

    2006-01-01

    Subtalar arthroscopy has become a valuable adjunct to the tools used in lower extremity surgery. For the past 25 years, ankle arthroscopy has been in vogue for treating a variety of conditions. Subtalar arthroscopy has more treatment limitations and is more technically difficult to perform than ankle arthroscopy because of the anatomic confines and structure of the subtalar joint. Most procedures are performed on the posterior aspect of the subtalar joint. The subtalar joint is composed of three articulations (posterior, middle, and anterior facets) and is surrounded by a variety of intra-articular and extra-articular ligaments, whose anatomy must be fully understood before attempting this procedure. Subtalar arthroscopy may be indicated for diagnostic purposes and for débridement of synovial impingement syndromes in the sinus tarsi. It may be used to examine loose bodies or osteochondral lesions, to address fractures of the lateral process of the talus, and to evaluate subtalar instability to determine appropriate stabilization methods. Arthroscopic subtalar arthrodesis also has gained credibility over the past 10 years as an acceptable surgical procedure. Arthroscopic evaluation of subtalar instability is useful in planning the appropriate stabilization. Subtalar arthroscopy is usually performed with the patient in the lateral decubitus position without traction. Anterior and posterior portals as well as an accessory anterior portal are usually necessary to perform all of the above procedures. Because of the limited confines of the joint, care must be taken to prevent any articular cartilage damage. When performing subtalar arthroscopy in conjunction with ankle arthroscopy, the subtalar arthroscopy should be performed first to avoid excessive extravasation from the ankle arthroscopy, which could obscure entry to the subtalar joint. Complications of subtalar arthroscopy are similar to those encountered in ankle arthroscopy, such as damage to the sural and superficial peroneal nerves. PMID:16958488

  11. Quantification of active ROM after arthroscopic Bankart repair with rotator interval closure.

    PubMed

    Randelli, Pietro; Arrigoni, Paolo; Polli, Luca; Cabitza, Paolo; Denti, Matteo

    2009-06-01

    Several series report patients homogeneously treated using arthroscopic Bankart repair exclusively, or in some cases arthroscopic Bankart repair with rotator interval closure. Current international literature has few reports on arthroscopic Bankart repair with rotator interval closure procedures undertaken on a homogeneous series of patients. The purpose of this study was to evaluate the residual active range of motion (ROM) and clinical outcome in this patient population. Fourteen patients affected by recurrent anterior instability were consecutively treated. Rowe, Walch-Duplay, and UCLA scores, as well as differences in active ROM of both shoulders (treated and contralateral), were recorded. A significant reduction in active external rotation was noted along the side of the arm (P<.001) and at 90 degrees of abduction (P=.007). The average reduction was 12.14 degrees and 7.21 degrees, respectively, which represents 17.8% and 8% of the arc of motion of the opposite side in external rotation. No significant differences were found for flexion, abduction, and internal rotation. According to Walch-Duplay and Rowe scores, 71.4% and 85.7% of patients had excellent or good results. Arthroscopic Bankart repair with rotator interval closure results in a reduction of external rotation and provides satisfactory stability results. PMID:19634824

  12. Efficacy of Osseous Abnormalities Correction with Arthroscopic Surgery in Femoroacetabular Impingement

    PubMed Central

    Alvarez, Daniel R. Camacho; Mardones, Rodrigo M.

    2010-01-01

    Femoroacetabular impingement (FAI) is a clinical syndrome characterized by subtle abnormal morphology of the proximal femur and/or the acetabulum that leads to abnormal contact between the femoral neck and the acetabular rim during the hip range of motion. Traditionally, FAI has been managed safely and effectively with surgical hip dislocation; less invasive arthroscopic techniques are now being used to an increasing extent, trying to emulate the results of the open technique. The purpose of this study was to evaluate the radiographic results of arthroscopic acetabular rim trimming and femoral osteochondroplasty in FAI. This was a retrospective analysis of preoperative and postoperative plain radiographs of 80 patients treated for FAI with arthroscopic surgery between April 2007 and December 2008. We evaluated 2 parameters: the Wiberg angle (center-edge angle) (normal, 25°-35°), and the anterior/posterior relation of femoral head-neck offset (normal, 0.8-1). Of 80 hips, 10 (12.5%) were pincer-type impingement, 17 (21.25%) were cam type, and 53 (66.25%) were mixed type. The preoperative Wiberg average was 39° (range, 25°-51°), and the postoperative Wiberg average was 32° (range, 25°-42°). The preoperative anterior/posterior femoral offset relation average was 0.42 (range, ?0.38 to 1), and the postoperative anterior/posterior femoral offset relation average was 0.94 (range, 0.61-1.2). Our results show that it is possible to obtain an anatomical correction of the osseous abnormalities with arthroscopic surgery in FAI. Level of evidence: level III.

  13. Direct Arthroscopic Distal Clavicle Resection

    PubMed Central

    Lervick, Gregory N

    2005-01-01

    Degenerative change involving the acromioclavicular (AC) is frequently seen as part of a normal aging process. Occasionally, this results in a painful clinical condition. Although AC joint symptoms commonly occur in conjunction with other shoulder pathology, they may occur in isolation. Treatment of isolated AC joint osteoarthritis is initially non-surgical. When such treatment fails to provide lasting relief, surgical treatment is warranted. Direct (superior) arthroscopic resection of the distal (lateral) end of the clavicle is a successful method of treating the condition, as well as other isolated conditions of the AC joint. The following article reviews appropriate patient evaluation, surgical indications and technique. PMID:16089089

  14. A comparison of pre-operative evaluation of anterior knee laxity by dynamic X-rays and by the arthrometer KT 1000

    Microsoft Academic Search

    J. L. Lerat; B. Moyen; J. Y. Jenny; J. P. Perrier

    1993-01-01

    The comparison of bilateral dynamic X-rays in passive anterior and posterior drawer with a load of 9 kg. and the arthrometer KT 1000 measurements obtained from 100 patients before anterior cruciate ligament reconstruction, confirms the good diagnostic efficiency of the following methods: (1) radiological measurement of the anterior translation of the medial compartment, as an absolute value and especially as

  15. Revision of Failed Arthroscopic Bankart Repairs

    Microsoft Academic Search

    Domenick J. Sisto

    2007-01-01

    Background: The results following open revision surgery following a failed arthroscopic Bankart procedure are not well documented.Purpose: To evaluate the results of patients with a failed arthroscopic Bankart repair treated with a traditional, open Bankart repair.Study Design: Case series; Level of evidence, 4.Methods: Thirty patients (28 male and 2 female) who had a mean age of 24 years (range 15-36)

  16. Arthroscopic Allograft Cartilage Transfer for Osteochondral Defects of the Talus

    PubMed Central

    Min, Kyong S.; Ryan, Paul M.

    2015-01-01

    Arthroscopic treatment of osteochondral defects is well established but has had mixed results in larger lesions and revision operations. Particulated allograft cartilage transfer may provide an arthroscopic option for lesions that would otherwise have been treated through open approaches or osteotomies. The procedure is performed under noninvasive distraction with standard arthroscopic portals. PMID:26052496

  17. Arthroscopic quadriceps tendon repair: two case reports.

    PubMed

    Saito, Hidetomo; Shimada, Yoichi; Yamamura, Toshiaki; Yamada, Shin; Sato, Takahiro; Nozaka, Koji; Kijima, Hiroaki; Saito, Kimio

    2015-01-01

    Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury. PMID:25815224

  18. Arthroscopic Quadriceps Tendon Repair: Two Case Reports

    PubMed Central

    Saito, Hidetomo; Shimada, Yoichi; Yamamura, Toshiaki; Yamada, Shin; Sato, Takahiro; Nozaka, Koji; Kijima, Hiroaki; Saito, Kimio

    2015-01-01

    Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury. PMID:25815224

  19. Comparison of open and arthroscopic subacromial decompression.

    PubMed

    Lazarus, M D; Chansky, H A; Misra, S; Williams, G R; Iannotti, J P

    1994-01-01

    We retrospectively reviewed 68 patients (70 shoulders) who underwent either open or arthroscopic acromioplasty performed by a single surgeon (JPI) for chronic impingement syndrome in the presence of an intact rotator cuff. Group 1 consisted of 24 shoulders that had open acromioplasty and group 2 consisted of 46 shoulders that had arthroscopic acromioplasty. The minimum follow-up was 12 months for both groups. There was no statistical difference in mean postoperative shoulder scores between the operative groups. However, there were more excellent results in the open group as compared with the arthroscopic group (54.2% vs 41.9%, respectively). In addition, there was a higher percentage of poor results in group 2 as compared with group 1 (27.9% vs 16.6%, respectively). Arthroscopic acromioplasty was associated with shorter hospital stays and faster achievement of maximal pain relief as compared with open acromioplasty. Examination of postoperative radiographs often revealed subacromial calcifications. These calcifications were more frequent after arthroscopic acromioplasty and were associated with a worse result. PMID:22959606

  20. Arthroscopic landmarks of the equine carpus.

    PubMed

    Hurtig, M B; Fretz, P B

    1986-11-15

    The radiocarpal and middle carpal joints of 4 clinically normal horses and 24 necropsy specimens were examined with an arthroscope to describe the topographic anatomy of these joints. The carpal bones of the radiocarpal joint had congruent articular surfaces in extension, but carpal flexion resulted in a stairstep between the radial and intermediate carpal bones. The variable surface anatomy, as well as the restricted synovial space and the technical limitations of the arthroscope, contributed to the need for more than one arthroscopic approach to the radiocarpal joint to ensure a thorough examination. The middle carpal joint's hinge-like biomechanics resulted in a spacious synovial cavity that was more amenable to arthroscopic examination. Careful planning was necessary to ensure that areas of interest were distant from the arthroscope-insertion site to allow the best perspective possible. The lateral approach to the middle carpal joint provided the best viewing of both facets of the intermediate and third carpal bones as well as the dorsal rim of the radial carpal bone. The medial approach did not allow complete inspection of these areas. PMID:3793573